Frozen shoulder is a term collectively used to describe a variety of conditions that 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 the 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:
- Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
- Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
- 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 the pain limit initially and then can be taken slightly beyond.
Stretching of muscles and joint capsules 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
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