Frozen Shoulder 


Frozen Shoulder 

Frozen shoulder, also known as adhesive capsulitis, is a condition that limits movement in the shoulder joint. It usually goes through stages, increasing in pain and stiffness over time. Although the exact cause is unknown, it is characterized by inflammation and thickening of the capsule around the shoulder joint, limiting its range of motion.

What are the Symptoms?

Frozen shoulder typically goes through three stages, each with distinct symptoms:

Freezing phase (first few weeks to months): 

  • Gradual onset of shoulder pain, often worse at night. 
  • Pain increases with movement, especially reaching to the top or back of the head. 
  • Difficulty sleeping due to pain. 

Frozen phase (4-6 months): 

  • The pain may be less severe but the stiffness becomes more noticeable. 
  • Significant range of motion of the shoulder, making daily activities difficult. 
  • Difficulty raising the arm overhead or across the body. 

The melting phase (6 months to 2 years or more): 

  • Gradual improvement in range of motion and reduction in stiffness. 
  • The pain subsides over time. 
  • Full recovery of movement may not always be achieved, but significant improvement is usually seen.

What are the Causes & Risk Factor?

The exact cause of frozen shoulder is not fully understood. However, several factors are believed to contribute to its development:

Predisposing factors of frozen shoulder/ People at risk

Certain factors can increase your risk of developing frozen shoulder:

Diagnosis of Frozen Shoulder

Diagnosis of frozen shoulder usually includes:

 A health care professional will examine your shoulder to identify: 

  • Location and intensity of pain: They will move the shoulder to identify the location of tenderness and assess the degree of pain. 
  • Range of motion: They will gently test the range of motion in your shoulder in different directions to assess the range of stiffness. 
  • Passive range of motion: They may gently move your arm to assess the range of motion due to stiffness. 

Imaging tests are not usually necessary for diagnosis but can sometimes be helpful in ruling out other conditions: 

  • X-rays: X-rays can help identify any underlying bone abnormalities or fractures in the shoulder joint. 
  • MRI scan: In rare cases, an MRI scan may be used to look at soft tissues such as the capsule and rotator cuff for a more detailed diagnosis, especially if there is a variety of shoulder pain and stiffness. Any concerns about the underlying cause. 

Treatment options for frozen shoulder

Treatment focuses on managing pain, improving mobility, and preventing further stiffness. Here’s an overview of common

  • Pain medications: Over-the-counter pain relievers (ibuprofen, acetaminophen) or stronger prescription pain medications can be used to manage pain and discomfort. 
  • Pain management techniques: Strategies such as ultrasound therapy, heat therapy, or electrical stimulation can be used to manage pain and inflammation. 
  • Gentle stretching exercises: Gentle stretching exercises to improve flexibility and range of motion in the shoulder joint. These exercises should be done within your pain tolerance to avoid further injury. 
  • Strengthening exercises: As pain and stiffness improve, strengthening exercises for the muscles around the shoulder joint, including the rotator cuff and core muscles, will be added to the program. This helps improve stability and prevent future problems. 
  • Corticosteroid injection: In some cases, injecting corticosteroids directly into the shoulder joint can relieve pain and reduce inflammation, helping with physical therapy exercises. However, repeated injections are not recommended due to possible side effects. 
  • Manipulation under anesthesia (MUA): In severe cases with significant stiffness, a healthcare professional may recommend manipulation under anesthesia (MUA). This procedure involves gently stretching the shoulder capsule while you are under anesthesia to improve range of motion. This is usually followed by intensive physical therapy to maintain increased mobility. 

Frozen shoulder surgery is rarely necessary and is usually only considered in rare situations when conservative treatment fails to provide significant improvement after a long period of time (usually more than a year). Surgical procedures may include: 

  • Arthroscopic capsule release: A minimally invasive procedure using a camera and small instruments to cut or release narrow portions of the shoulder capsule to improve mobility. 
  • Open capsule release: In some cases, a traditional open incision may be necessary for a more extensive release of the capsule. 

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