Frozen shoulder, medically known as adhesive capsulitis, is a common yet often debilitating condition characterized by pain and a profound loss of both active and passive range of motion in the shoulder joint. It's a condition that essentially causes the shoulder to become "stuck" due to thickening and tightening of the connective tissue capsule that surrounds the joint.
While the exact cause, or etiology, remains unclear (often termed idiopathic), it is known to involve inflammation, fibrosis, and contracture of the joint capsule. This complex process restricts movement, turning simple daily tasks like dressing or reaching for an object into painful struggles.
Key Facts and Risk Factors
Frozen shoulder most commonly affects individuals between 40 and 60 years old, with a slight predominance in women. It usually affects only one shoulder, but it can occur in the other shoulder later on.
Several factors are known to increase the risk of developing this condition:
- Diabetes Mellitus: This is the most significant risk factor, with people with diabetes being up to 20% more likely to develop frozen shoulder. Diabetic patients often experience more severe and prolonged stiffness.
Immobility/Reduced Mobility: Prolonged stillness of the shoulder due to injury (like a fracture), stroke, or recovery from surgery is a major precipitating factor.
- Other Systemic Diseases: Conditions such as hypo- or hyperthyroidism, Parkinson's disease, and cardiovascular disease are also associated with an increased risk.
The Three Stages of Progression
Frozen shoulder typically develops slowly over time and progresses through distinct phases, though the duration can vary significantly among individuals:
1. Freezing Stage (Painful Stage):- Duration: Typically 2 to 9 months.
- Symptoms: This stage begins with a gradual onset of pain, often worsening at night. As the pain intensifies, the patient instinctively limits shoulder movement, and the range of motion slowly starts to decrease.
- Symptoms: The pain may start to lessen, but the stiffness dramatically increases, making the shoulder extremely difficult to move. The loss of range of motion plateaus, severely impacting the ability to perform daily activities.
- Duration: Highly variable, lasting from 5 to 24 months.
- Symptoms: The shoulder's range of motion slowly and gradually begins to improve. Full recovery can take a significant amount of time, sometimes up to three years, though most patients regain good function.
Diagnosis and Treatment
Diagnosis is primarily clinical, based on the patient's history, the progressive nature of the pain and stiffness, and a physical exam demonstrating a significant loss of both active (patient-initiated) and passive (doctor-assisted) range of motion. Imaging like X-rays or MRI may be used to rule out other conditions such as arthritis or a rotator cuff tear.
The good news is that frozen shoulder is generally considered a self-limiting condition, meaning it typically resolves on its own, though it can take a long time. The goal of treatment is to control pain and restore mobility and strength.
Non-Surgical Treatment (The First Line of Defense):
- Physical Therapy (Physiotherapy): This is the cornerstone of treatment, focusing on specific stretching and range-of-motion exercises to maintain and restore flexibility. The intensity of therapy is often matched to the patient's stage of the condition.
Medication: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen can help manage pain and inflammation, particularly in the early, painful stage.
Steroid Injections: Injecting a powerful anti-inflammatory medicine (cortisone) directly into the shoulder joint can provide significant, short-term pain relief and improve motion, especially if administered early in the freezing phase.
- Hydrodilatation: Involves gently injecting sterile fluid into the joint to stretch and expand the thickened capsule.
Surgical Treatment:
Surgery is typically reserved for patients whose symptoms persist despite extensive conservative management, often during the frozen stage. Procedures include:
- Manipulation Under Anesthesia (MUA): The patient is put to sleep, and the surgeon forcefully moves the shoulder to break up the scar tissue.
- Arthroscopic Capsular Release: A minimally invasive procedure where the tight portions of the joint capsule are surgically cut or released to restore movement.
Prevention
For those recovering from a shoulder injury or surgery, preventing immobilization is key. Working with a healthcare provider or physical therapist on gentle, early range-of-motion exercises is the best preventative strategy to keep the shoulder capsule from stiffening.
If you suspect you may have frozen shoulder, early consultation with a healthcare professional is crucial for a definitive diagnosis and to start a tailored treatment plan to manage the symptoms and minimize the overall duration of the condition.
Disclaimer: This content is published only for health awareness and informational purposes. It's not a substitute for your professional medical advice. You must consult a doctor/healthcare professional regarding your specific health concerns.
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