Definition
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.
Your risk of developing frozen shoulder increases if you're recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.
Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.
Causes of a frozen shoulder
Whilst the exact cause of a frozen shoulder is not exactly known, it is thought to occur following injury or damage to the shoulder joint or adjacent soft tissue. In these cases, a frozen shoulder is more likely to develop if the initial injury is not treated appropriately. This often occurs due to inadequate rest from aggravating activities or adopting a 'no pain no gain' attitude. A patient may also have an increased likelihood of developing the condition following excessive immobility (i.e. not moving the shoulder, particularly after injury or surgery) or if they suffer from other auto-immune diseases or diabetes.
Signs and symptoms of a frozen shoulder
The symptoms associated with this condition usually develop gradually over time (often following a recent history of shoulder injury, surgery and/or immobilisation). Patients typically experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be focused deep in the shoulder, however may occasionally be experienced in the upper arm, upper back and neck. Patients may also experience stiffness in each of these regions.
The pain associated with a frozen shoulder may increase with any movement of the shoulder and with activities placing stress on the shoulder joint. These activities may include: arm elevation, lifting, carrying, pushing or pulling, lying on the affected side and taking your hand behind your back (e.g. putting on a bra). Patients with a frozen shoulder often experience pain at night or upon waking in the morning. As the condition progresses from the painful phase to the frozen phase, pain may reduce significantly.
Aside from pain, patients also typically experience marked stiffness and significantly reduced range of movement of the shoulder. This typically affects all shoulder movements, but is most noticeable with rotation and elevation. This may present as difficulty elevating the affected arm or an inability to take the hand behind the back. As this condition progresses from the frozen phase to the thawing phase, range of movement gradually increases with a subsequent reduction in joint stiffness. Patients may also develop muscle wasting in the affected arm, as the condition progresses, through lack of use.
Although a frozen shoulder generally affects only one side, some patients may develop the condition in both shoulders.
Tests and diagnosis
During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:
- Hands up.Raise both your hands straight up in the air, like a football referee calling a touchdown.
- Opposite shoulder.Reach across your chest to touch your opposite shoulder.
- Back scratch.Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.
Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.
Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.
Treatments
Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.
- Medications
The aim of treatment is to ease pain and stiffness; also, to keep the range of shoulder movement as good as possible whilst waiting for the condition to clear. One or more of the following may be advised to help ease and prevent symptoms:
· Ordinary painkillers
Paracetamol may be advised first to try to control the pain. Codeine is a stronger painkiller which may be used as an alternative to, or in addition to, paracetamol. Constipation is a common side-effect from codeine. You can take ordinary painkillers in addition to other treatments.
· Anti-inflammatory painkillers
Examples anti-inflammatory painkillers include ibuprofen, diclofenac and naproxen. These drugs work by helping to ease pain and also by reducing any swelling (inflammation) in your shoulder. There are many different brands. Therefore, if one does not suit, another may be fine. Side-effects sometimes occur with anti-inflammatory painkillers. Always read the leaflet that comes with the drug packet for a full list of cautions and possible side-effects.
Physiotherapy
Many people are referred to a physiotherapist who can give expert advice on the best exercises to use. Also, they may try other pain-relieving techniques such as warm or cold temperature packs and transcutaneous electrical nerve stimulation (TENS) machines.
- Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
Also Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
Laser Therapy Treatment
Laser therapy treatments over a period of several weeks will reduce the chronic inflammation within the joint, gradually restoring range of motion and normal function. Patients who were formerly told to just wait for it to heal - which could take several years - can now receive laser therapy treatments to get them back to normal daily function much more quickly than without treatment. Once the initial stage of care is completed, laser treatments are given in conjunction with a customized stretching exercise plan to increase range of motion and restore proper function of the shoulder.
exercise
Frozen shoulder exercises are very important in healing a stiff or frozen shoulder. These exercises assist in reducing pain, boost enlargement of the capsule and build strength of the rotator cuffs tendons. They also help to regain mobility and use of the arm suffering from a frozen shoulder. The muscles are strengthened by the exercises and full recovery is possible. Mobility is achieved by relaxation, passive mobilization skills and specific movements that will guarantee the required results. It is important to follow the whole program to ensure real change is achieved. Shoulder stretches are an excellent tool to help facilitate the healing process. While performing the movements bear in mind that any chance of re-injury will extend the problem. It is very necessary to avoid re-injuring the shoulder while performing your exercises.
- Shoulder manipulation.In this procedure, you receive a general anesthetic so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
- If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.
