Frozen Shoulder

Frozen shoulder or adhesive capsulitis refers to the stiffness and loss of range of motion of the shoulder. The shoulder joint stiffens, making movements very painful and limited.

The pain and stiffness develop gradually and may persist for a year or two. It is more frequently found in women in the age group of 40-60 years.

The condition is found in association with chronic diseases like diabetes and cardiac disease. It may also develop after a surgery or an injury that limits the movement of the arm.

The pain and stiffness get better with time but it may take years for the symptoms to resolve. Frozen shoulders can be improved by medications, injections, exercise and surgery.

Recurrence of stiffness in the shoulder is uncommon, but in some cases it may develop in the opposite shoulder.

Pain, stiffness, and difficulty in moving the shoulder are the main symptoms of this condition. It usually starts with pain in one of the arms, which makes it difficult to move freely.

The symptoms develops in three stages:

• Freezing stage – in this stage the ability to move the shoulder reduces. Movement of the arm, particularly the shoulders, causes pain. This stage may last for 6 weeks to 9 months.
• Frozen stage – pain is lesser, but the movement is very limited. Stiffness is felt all the more in this stage which last for one to four months.
• Thawing stage – movement improves gradually and the shoulders may return to their full functioning within 6 months to 2 years.

The causes of frozen shoulders are not known fully. Movement of the shoulder is restricted by the thickening of the capsule covering the shoulder joint.

Some of the common risk factors include:

• Diseases – frozen shoulders are found more frequently in people with diabetes. Other conditions like hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease also increase a risk of developing stiff shoulders.
• Immobilization – when the shoulder is not used for a period of time due to surgery, injury, or a fracture, the risk of shoulder stiffness is more. Rotator cuff injury and stroke also increase the risk of the condition.

Medical history and physical examination are the first steps in the diagnosis of frozen shoulder. Testing the range of motion of shoulders helps to assess the extent of stiffness. It also helps to note the extent of movement with and without pain.

The range of motion of shoulder joint with the help of another person, called passive range of motion, is compared with the range of motion without any help (active range of motion). Both active and passive range of motion are limited in people with frozen shoulders.

Other causes of stiffness and pain are ruled out by using imaging techniques. X-ray help to differentiate pain due to arthritis while MRI may be recommended to detect rotator cuff injury.

Frozen shoulder may resolve on its own without any specific treatment in most of the people. But it may take up to 3 years for the symptoms to be relieved.

• Physical therapy is suggested to reduce pain and to improve the range of motion of the affected shoulder. It comprises of a set of exercises performed under the guidance of a physical therapist. External rotation, forward flexion, and crossover arm stretch are some of the common exercises suggested in physical therapy.
• Non-steroidal anti-inflammatory medications help in reducing pain and inflammation of the joint.
• Steroid injections, given directly into the joint, helps to reduce inflammation.
• Surgery is suggested when the symptoms are not relieved by anti-inflammatory medications or physical therapy. Surgical method aids in stretching and releasing the stiff joint. In a shoulder arthroscopy, the tight capsule of the joint is cut. Physical therapy is necessary to improve the range of motion of the shoulder after the surgery. The full function of the shoulder joint may be recovered within 3-4 months. Recurrence is rare, but in some cases, stiffness may return, particularly in diabetes patients.

Maintaining the range of motion through physical exercise as soon as possible is the best way to prevent frozen shoulders.

Immobilization of the shoulders after a surgery or injury is one of the most common cause of frozen shoulders.

A few alternative and homeopathic remedies exist for frozen shoulder.

Acupuncture and transcutaneous electrical nerve stimulation (TENS) methods are also used in the treatment of frozen shoulders.

Acupuncture is a relatively painless method to relieve the symptoms of this condition. In TENS, small units of electrical current are focused on the affected region to reduce the pain associated with stiffness.

Calc phos and Ferrum met are recommended in homeopathy to reduce pain in the affected shoulder. Rhus tox is used to improve stiffness and inflammation in the joint. Sanguinaria helps to improve the motion of the shoulder.

Lifestyle modifications are necessary in order to cope with frozen shoulder.

Maintaining the range of motion through recommended exercises is very important in improving the symptoms.

Heat pads applied in the affected shoulder help to relieve pain.

There are several risks and complications associated with frozen shoulder.

In some rare cases, pain and stiffness may persist even after the treatment.

Surgery may lead to tendon rupture and fracture.