Frozen shoulder or adhesive capsulitis:
Frozen shoulder is also known as adhesive capsulitis. This condition is also known as frozen shoulder syndrome or FSS. It is a condition involving pain and immobility or stiffness of the shoulder and it is a progressive condition. So it means it gets worse over time.
Types of frozen shoulder:
Adhesive capsulitis is broke down into two types one is known as primary adhesive capsulatus. It arises spontaneous and its cause is not known. The second type is secondary adhesive capsulated which is going to be due to some other underlying cause.
Mostly the ages of 40 to 60 patients experience frozen shoulder syndrome. And the lifetime estimate of having this condition is two to five percent of the gender population. And females are more likely to affect with this condition than male patients. It is roughly four times higher likely in females compared to males.
Causes of secondary adhesive capsulitis or frozen shoulder:
As mention early primary adhesive capsulatis is idiopathic. Its means that it causes is not known. But secondary adhesive capsulatus has a wide variety of causes.
1.Shoulder immobilization:
The term means that the patient's shoulder will not move for a very long time. This is actually a very important cause of this condition.
2.Diabetes:
It is an important underlying cause of adhesive capsulitis as well and this is consider to be an independent risk factor. It increase the likelihood of having adhesive capsulitis by nearly five times. So it's five times more likely to occur in diabetic patients than non-diabetic patients.
3.Hyperthyroidism:
Having hyperthyroidism is a high functioning thyroid. It is also an associate cause of frozen shoulder.
4.Parkinson's disease:
It is also another potential underlying cause.
5. Stroke:
Having a stroke is also an important associated factor with adhesive capsulitis.
6.Shoulder injury:
Having a shoulder injury being an important cause of this condition as well.
7.Complex regional pain syndrome:
It is another Associate Factor as well.
8. Cancer:
Cancer can also be an underlying cause of secondary adhesive capsulitis.
Clinical features of frozen shoulder:
The patient's non-dominant shoulder is mostly affect. So this condition is going to be unilateral. It means that it's only going to affect one shoulder as opposed to both shoulders. Although bilateral cases can occur in rare instances.
What are the stages of frozen shoulder?
There are three phases of adhesive capsulitis or frozen shoulder.
- Freezing phase
- Frozen phase
- Thawing phase
1.Freezing phase:
As his name implies it occurs slowly over time and it involves pain that progressively worsens. It presents over the outer shoulder and the upper arm. It often occurs over six to nine months or up to nine months. In this phase inflammation of the joint capsule occurs.
2.Frozen phase:
In the past, there is a progressive stiffening. It’s going to lead to this fibrosis of that joint capsule. Then the joint capsule becomes harder and stiff so cannot move easily. It often leads to severe restriction of movement especially external rotation is limited. This phase occurs over four to twenty months.
3.Thawing phase:
There is a gradual resolution of symptoms and the range of motion of the shoulder slowly improves and residual pain resolves. There may be some residual pain. This occurs over 5 to 26 months.
Clinicians diagnose of adhesive capsulitis or frozen shoulder:
The frozen shoulder can be diagnosis through these things such as:
- Getting the history of prolonged shoulder immobility
- Diabetes
- The pattern of signs and symptoms, it must have persisted for at least three months
- Radiological Imaging may use in some cases. Firstly x-ray and secondly musculoskeletal ultrasonography can use in some cases.
Treatment of frozen shoulder or adhesive capsulitis :
It is a self-limiting condition. The primary adhesive capsulated resolves on its own within 9 to 18 months up to three years on average and oftentimes secondary adhesive capsulitis has a poor prognosis. It may take longer or may be more difficult to resolve fully.
Freezing phase:
There are three treatment that are mostly use in freezing phase:
- In the freezing phase, pain management is very important. So use the non-steroidal anti-inflammatory drugs NSAIDs for example Motrin, naproxen, and ibuprofen. These drugs help in the reduction of inflammation in the joint capsule. And it also reduces the pain that helps prevent further immobility. If the patient has pain in that shoulder they often will not use that shoulder much. Because movement can worsen the condition.
- Another way of dealing with the pain can be a corticosteroid injection as well.
- The third is therapy. It is important in the freezing phase. Physiotherapy doing exercises that are a passive and active range of motions. So, movement improves resolution because of that pain and the limited shoulder use. This can lead to more thickening of the joint capsule. so pain management keeps the pain low and the patient uses their shoulder.
Thawing phase :
Most cases are going to resolve slowly on their own. But if there is limit Improvement surgery may utilize in limited cases.
- Frozen shoulder surgery technique can be manipulate under anesthesia. And the patient is put under anesthesia and then there is the very rigorous movement of the shoulder to essentially break the shoulder capsule that thickens the shoulder capsule that prevents movement.
- Another one is arthroscopic capsular release. Again it breaks the thickened capsule. That allows the patient to move their arm or shoulder properly.