Background
Adhesive capsulitis, commonly termed frozen shoulder, is described by pain and tightening of the shoulder joint. The inflammation of the involved tissues may get so severe, causing marked restricted motion of the affected shoulder.
This condition is usually seen in individuals over the age of 40, affecting more women than men.
The shoulder is classified as a ball-and-socket joint that allows the humerus, or upper arm, a great range of motion. Because of the way the shoulder joint is designed, it has the ability to move in all three planes and achieve rotary movements with so much ease.
The head of the humerus is securely stabilized into the socket of the shoulder, located in the shoulder blade, by a strong group of connective tissues.
After an episode of inflammation in the shoulder capsule, a scar-like tissue may form in this area, which results in severe tightening of the joint. The marked stiffness of the joint gives rise to a frozen shoulder.
Causes
The exact or root cause of frozen shoulder is not clearly determined. It is observed, though, that this condition frequently follows an injury or trauma to the shoulder joint or its surrounding tissues.
The likelihood of frozen shoulder increases when the initial injury is left untreated or inappropriately managed. Prolonged immobilization of the shoulder joint after an injury, pain or surgery, could also give rise to severe joint tightening.
Signs and Symptoms
The signs and symptoms relating to frozen shoulder may vary, depending on the stage of the condition. In general, frozen shoulder is divided into three phases, each of which could last for several months:
- Phase One: The Freezing Phase
This stage is characterized by shoulder pain with any movement. The pain gets worse at night, most especially if lying on the affected side. The shoulder’s range of motion starts to get limited. This phase usually lasts for 2 to 9 months.
- Phase Two: The Frozen Phase
Marked joint stiffness and limitation of all shoulder motions characterize the second phase. Outward arm rotation is the most severely affected movement. The pain is usually reduced in intensity.
Because of immobilization or disuse, wasting of the shoulder muscles could also occur. This stage typically lasts for 4 to 12 months.
- Phase Three: The Thawing Phase
The third phase is the thawing or recovery stage. Lasting for 5 to 24 months, the joint stiffness gradually reduces and shoulder mobility increasingly returns to normal.
An untreated frozen shoulder may demonstrate these signs and symptoms for 2 to 3 years. The severity of the manifestations may also greatly vary.
Diagnosis
A thorough physical examination and a detailed medical history are usually the bases for frozen shoulder diagnosis. An X-ray or MRI might be necessary to rule out the occurrence of an underlying medical condition.
Treatment
The treatment for frozen shoulder includes shoulder pain alleviation and control and preservation of the shoulder’s range of motion.
Non-steroidal anti-inflammatory medications are prescribed to relieve the pain and inflammation associated to frozen shoulder. In severe cases of pain, a steroid injection might be necessary.
Steroids could greatly reduce inflammation and bring about pain relief for weeks. Regular administration of this medication has its downside as it can cause weakness of the shoulder tendons.
Shoulder exercises are advised to be done regularly. These exercises intend to preserve the shoulder’s range of motion and prevent the stiffening up of the affected joint. A regular session with a physical therapist might be indicated to help with the exercises.
It is recommended to continue using the affected shoulder in doing daily activities within the level of comfort to prevent muscle wasting. A heat or cold application can be beneficial in relieving the pain.
For a frozen shoulder unresponsive to conservative treatments, surgeries and other procedures might be needed. Injection of sterile water into the affected joint can stretch the scarred tissues.
Shoulder manipulation, under a general anesthesia, could loosen the tightened tissues and help regain shoulder mobility. An arthroscopic surgery to remove the scarred tissues is usually indicated if the symptoms do not respond to other measures.
