Frozen Shoulder(Adhesive capsulitis )
Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable. This process may take a long time, sometimes as long as two or more years. The lining of the shoulder joint, known as the capsule, is normally a very flexible elastic stucture. Its looseness and elasticity allows the huge range of movement of the shoulder joint. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen and contracted. The normal elasticity is lost and pain and stiffness set in, which leads to restriction of shoulder movements.The usual age of onset begins between ages 35 and 65. It affects approximately 10% to 20% of diabetics.
Other factors include: - a period of immobility, resulting from trauma, overuse injuries or surgery, hyperthyroidism, cardiovascular disease, clinical depression and Parkinson's disease.
Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm.
The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient.
course of a frozen shoulder as having three stages
- Stage I : synovitis stage (0 - 3 months)
- Stage II : In the "freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. This stage may last from six weeks to nine months.
- Stage III : The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.
- Stage IV : The final stage is the "thawing," during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.
A doctor can diagnose frozen shoulder based on the patient's symptoms and a physical examination.
X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as a rotator cuff tear
Anti-inflammatory drugs and cortisone injections reduce the inflammation in early stages of the disease allowing the shoulder to be more easily stretched.
Physio therapy is essential because it helps regain the range of motion in the shoulder.
Exercises will help break up the scar tissue in the shoulder . The doctor or physio- therapist will show the patient what kind of exercises should be performed. Since the exercises may be painful, using ice packs afterwards may help. With all exercises, the patient should warm up before attempting to do them.
Manipulation : If progress is slow, the doctor may recommend a manipulation of the shoulder while the patient is under anesthesia. This procedure allows the doctor to stretch the shoulder joint capsule, and break up the scar tissue. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course in mild to moderate cases.
Arthroscopic Surgical Release
In resistant, very stiff and in already manipulated patients direct arthroscopic visualization and relese of the tightened capsule is the treatment of choice in our institute.