Frozen shoulder is a term collectively used to
describe a variety of conditions which lead to stiffness and restriction of
movement in the shoulder joint. The technical term is adhesive capsulitis, that
is, stiffness and inflammation in the shoulder joint capsule (a structure that
encloses the joint). The shoulder complex consists of 4 different joints and is
a highly mobile joint complex that gives 3 degrees of freedom. But it also gets
restricted very quickly. Frozen shoulder usually means restriction of only the
ball and socket type (Gleno-humeral) of shoulder joint.
Causes/ Risk factors
The exact cause can at times be unknown but
there are a number of factors that can increase the risk of acquiring this
condition.
Immobilization:
1) post traumatic- fractures, soft tissue injuries (tendon or ligament)
2) After any surgery
around shoulder joint- breast surgeries
3) generalized
debility causing disuse
Neurological
conditions: stroke, any variation in muscle tone leading
to improper use of the joint.
Repetitive
stress disorders: activities that involve overuse
of the joint that causes micro trauma to soft tissues which in turn causes pain
and disuse.
Diabetes
Age:
senility can predispose a person to adhesive capsulitis.
Stages of frozen shoulder:
1)
Painful stage. During
this stage, pain occurs with any movement of your shoulder, and your shoulder's
range of motion starts to become limited.
2)
Frozen stage. Pain may
begin to diminish during this stage. However, your shoulder becomes stiffer,
and your range of motion decreases notably.
3)
Thawing stage. During
the thawing stage, the range of motion in your shoulder begins to improve.
Treatment
Medical
Patients can take
anti-inflammatory and pain killers in the initial stage to reduce pain and
swelling. If painkillers are not helping control the pain, it may be
possible to have a corticosteroid injection in your shoulder joint.
Electrotherapeutic
modalities like ultrasound can help reduce
pain and inflammation in stage 1. It can also help break down adhesions and
promote healing.
Exercises
Exercise is the
mainstay in treating frozen shoulder. Most patients respond well to home
exercise programs.
Exercises involve
mobility exercises that move the joint in all directions and through different
ranges within pain limit initially and then can be taken slightly beyond.
Stretching of
muscles and joint capsule can be done by the therapist or even self stretches
taught to the patient.
Joint
mobilizations administered by a physiotherapist. These involve passive glides
to the joint that can help break adhesions, improve mobility and even reduce
pain.
Most patients
respond very well to conservative management. In rare cases surgical
intervention may be required.
Surgeries:
Some of the
interventions may be:-
Manipulation under
general anesthesia
Arthroscopic
release of the capsule
Further
reading