Frozen Shoulder [Shoulder]

Overview

Frozen shoulder, or adhesive capsulitis is a common condition affecting people generally between the ages of 40-65, especially in people with a history of diabetes, thyroid problems, Parkinson’s, or cardiac disease. Patients with frozen shoulder have progressive loss of range of motion and pain with any motion of the affected shoulder.

The shoulder is a ball and socket joint, but the anatomy of the shoulder allows for an amazing amount of flexibility. The humeral head, or ball, sits on the glenoid, a very shallow socket. It resembles a golf ball on a tee. Because the socket is so shallow, the shoulder relies on the soft tissue around the shoulder for stability. The labrum, a thickened cartilage layer around the glenoid, and the ligaments and capsule, provide a majority of the stability to the shoulder. The muscles of the rotator cuff and scapula also provide stability.

Symptoms

Patients with frozen shoulder usually have increasing pain as their shoulder loses motion. The pain is often exacerbated by quick motions of the shoulder. The shoulder becomes more painful as the stiffness worsens, and it is difficult even for other people to move the shoulder. Diagnosis is usually made by physical exam. Radiographs and MRI are often obtained to rule out other problems in the shoulder.

Frozen shoulder causes

Inflammation: Inflammation causes parts of the joint capsule in the shoulder joint to become fibrotic, reducing the volume of the shoulder joint, limiting the shoulder’s ability to move and causing the shoulder to freeze.

No obvious cause: Frozen shoulder can happen with no obvious cause, which is known as primary frozen shoulder.

The cause of frozen shoulder is not understood. Patients with frozen shoulder have thickening of the capsule around the shoulder, which leads to pain and loss of motion. It is more common in diabetics, patients with thyroid disease, and patients who have had a previous shoulder injury and have been immobilized.

Classifications

Stage 1: “Freezing” Stage:

Characterized by a slow increase in pain, sometimes brought on by an apparently minor trauma. As the pain worsens, the shoulder loses motion.

Stage 2: “Frozen” Stage:

The pain improves, but the stiffness remains.

Stage 3: “Thawing” Stage:

Shoulder motion slowly returns to normal.

Stage 1 can last from 1 month to 9 months; stage 2 from 4 to 9 months, and stage 3 from 5 months to 2 years.

Frozen shoulder is a condition that results in loss of motion and pain or stiffness in the shoulder. The pain and loss of movement can be so severe that the performance of daily activities can become difficult. Also known as adhesive capsulitis, it most commonly affects adults between the ages of 40 and 60 years.

Frozen shoulder risk factors

Primary frozen shoulder is associated with several risk factors, including:

  • Age & gender: It tends to affect adults over 40 years and is more common in women.
  • Diseases & illnesses: Frozen shoulder also tends to occur more frequently in patients with endocrine disorders such as diabetes, cardiac disease or thyroid problems, Parkinson’s disease or if you have undergone surgery.
  • Immobility: In secondary frozen shoulder, this can occur commonly after prolonged immobilisation of the shoulder after injury, or due to pain that limits shoulder motion (such as after injury to the rotator cuff muscles of the shoulder) eventually leading to this disease.

Frozen shoulder symptoms

The most obvious symptoms are shoulder pain and a limited range of motion in the shoulder.

You may also have difficulties moving the shoulder normally and engaging in daily activities such as reaching across the table, putting on a shirt and overhead motions like combing hair. Motion is also limited on both passive and active motion.

Often, in the early stages, pain is a predominant symptom, and can affect sleep.

Frozen shoulder d​iagnosis

A frozen shoulder can be diagnosed on the basis of medical history and clinical examination. An x-ray or MRI can be used to rule out other causes such as arthritis and rotator cuff tears.

Frozen shoulder t​reatment

The initial aim of treatment for frozen shoulder is to reduce pain and inflammation as well as increase the range of motion of the shoulder. The course of treatment normally includes medications such as anti-inflammatory drugs. An injection of steroids to reduce the inflammation can sometimes be given. Physical therapy is most useful in restoring full range of motion to the shoulder.

If the frozen shoulder does not respond to non-surgical treatment, then surgery to release or stretch the scar tissue is an option. The most common methods include manipulation under anaesthesia and shoulder arthroscopy.

Manipulation, under anaesthesia, allows the surgeon to move the arm to break up the adhesions. No incisions are made.

In shoulder arthroscopy, a small camera and instruments are inserted through the small incisions made around the shoulder to cut through the tight portions of the joint capsule. Physiotherapy must follow the surgery to minimise the chance of the frozen shoulder returning.