Understanding Frozen Shoulder
Frozen shoulder, medically known as adhesive capsulitis, is a debilitating condition characterized by stiffness and pain in the shoulder joint. It typically develops gradually over time and can significantly limit your range of motion, making everyday activities challenging.
While the exact cause of frozen shoulder is often unknown, it is believed to occur when the tissues around the shoulder joint become thickened and tight, leading to inflammation and adhesions within the joint capsule. This results in the characteristic symptoms of pain and stiffness, which can persist for months or even years if left untreated.
Frozen shoulder is a condition in which the shoulder becomes markedly painful and stiff (loses its movement). It may follow an injury to the shoulder, but may also arise gradually without any injury. It also known as periarthritis or adhesive capsulitis.
The exact cause of this condition is still not very well understood. There is It is associated with severe inflammation of the shoulder joint capsule (causing pain) which leads to adhesions in and around the joint and contracture of the capsule (causing restriction of movements). This may occur spontaneously or following a trivial injury to the shoulder. It may be also be secondary to tendinitis (inflammation of a tendon) or, bursitis (inflammation of a bursa) or rotator cuff tear. It may follow after surgery on the shoulder or after prolonged shoulder immobilization. Patients with diabetes, stroke, lung disease, rheumatoid arthritis and hyperthyroidism are at a higher risk of developing frozen shoulder. In some patients frozen shoulder is associated with a pain syndrome called ‘reflex sympathetic dystrophy’ (RSD).
The diagnosis of frozen shoulder is made on the basis of patient’s symptoms and physical examination.
Frozen shoulder usually occurs between the age of 40 and 65 years and is more common in women than men. It usually affects the non-dominant arm (i.e. the left arm in a right-handed patient and vice versa), and in 10-15% of patients it may affect both shoulders at the same time. Patients will have severe pain and stiffness (restriction of all movements in the shoulder). The pain is typically present at rest and even at night. Physical examination of a frozen shoulder reveals limitation of both active (patient unable to move arm on his own) as well passive movements (examiner unable to move patient’s arm at the shoulder movements of the arm performed by the examiner). In a severe case, all movements of the shoulder are affected (global restriction of shoulder motion).The disease This condition tends to progresses in stages.
1. Stage one (freezing or painful phase): The “freezing” or painful stage,which may last from 6 weeks to 9 months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses its movement.This stage is characterized by slow onset of pain. As the pain worsens, the shoulder loses its movement. This stage may last from 6 weeks to 9 months.
2. Stage two (frozen or adhesive phase): The “frozen” or adhesive This stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts from 4 months to 9 months.
3. Stage three (thawing or recovery phase): The “thawing” or recovery stage,This is the stage during which shoulder motion movement slowly returns towards normal. This stage generally lasts from 5 months to 26 months.
There are no specific laboratory tests or investigations which will clinch the diagnosis of frozen shoulder. It is a diagnosis made on the basis of history of patient’s symptoms of pain and stiffness, and findings of global restriction of active as well as passive movements of shoulder on physical examination. Typically, X-rays and MRI scans of shoulder are normal in a case of primary frozen shoulder. These tests may be ordered in order to rule out other causes of shoulder pain and stiffness (like rotator cuff tears).