Frozen Shoulder (Adhesive Capsulitis) Causes, Symptoms, Diagnosis, Treatment, Prevention

Frozen Shoulder (Adhesive Capsulitis) Causes, Symptoms, Diagnosis, Treatment, Prevention


What is Frozen Shoulder (Adhesive Capsulitis)?


Frozen Shoulder (Adhesive Capsulitis) Causes, Symptoms, Diagnosis, Treatment, Prevention
Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder (adhesive capsulitis) is stiffness, pain, and limited range of movement in your shoulder camera that may follow an injury. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. The condition usually comes on slowly, then goes away slowly over the course of several months or longer.


Your risk of developing frozen shoulder increases if you're recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.


Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

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What causes Frozen Shoulder (Adhesive Capsulitis)?


The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren't sure why this happens to some people and not to others, although it's more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

Risk factors of Frozen Shoulder (Adhesive Capsulitis)


It is not fully understood why frozen shoulder occurs and, in some cases, it is not possible to identify a cause. However, a number of things can increase your risk of developing it. These are outlined below.

Shoulder injury or surgery


Frozen shoulder can sometimes develop after a shoulder or arm injury, such as a fracture, or after having surgery to your shoulder area.

This may partly be a result of keeping your arm and shoulder immobile (still) for long periods of time during your recovery. Your shoulder capsule may tighten up due to a lack of use.

For this reason, it is very important you do not ignore a painful shoulder injury and always seek medical advice.

Diabetes


If you have diabetes, your risk of developing a frozen shoulder is increased. The exact reason for this is unknown.

It is estimated that  people with diabetes are twice as likely to develop a frozen shoulder compared with those who do not have diabetes.

If you have diabetes, your frozen shoulder symptoms are likely to be more severe. You are also more likely to develop the condition in both shoulders.

Other health conditions


Your risk of developing a frozen shoulder may also be increased if you have other health conditions including:
  • Dupuytren's contracture - where small lumps of thickened tissue form in the hand, causing the fingers to bend into the palm of the hand
  • heart disease
  • stroke 
  • lung disease
  • thyroid disease 
  • breast cancer

Other shoulder conditions


Frozen shoulder can also sometimes develop in association with other shoulder conditions such as:
  • calcific tendonitis - where small amounts of calcium are deposited in the tendons of the shoulder
  • rotator cuff tear - the rotator cuff is a group of muscles that control shoulder movements

Immobility


Not moving for long periods of time is another risk factor for frozen shoulder. This can sometimes occur if you have to spend time in hospital - for example, after having a stroke or a car accident.

What are symptoms and signs of a Frozen Shoulder (Adhesive Capsulitis)?


Pain and persistent stiffness in the shoulder joint are the two main symptoms of a frozen shoulder.
This makes it painful and difficult to carry out the full range of normal shoulder movements. You may find it difficult to perform everyday tasks such as:


Frozen Shoulder (Adhesive Capsulitis) Causes, Symptoms, Diagnosis, Treatment, Prevention
Frozen Shoulder (Adhesive Capsulitis)

  • bathing
  • dressing
  • driving
  • sleeping comfortably
Symptoms may vary from mild, with little interference to daily activities, to severe, where it may not be possible to move your shoulder at all.

The symptoms of a frozen shoulder usually progress gradually over a number of months or years.
There are three separate stages to the condition, which can sometimes be difficult to distinguish. The symptoms may also vary greatly from person to person.

Stage one


During stage one, often referred to as the 'freezing' phase, your shoulder will start to ache and become very painful when reaching.

The pain is often worse at night and when yccc lie on the affected side. This stage may last 2-9 months

Stage two


Stage two is often known as the 'frozen' phase. Your shoulder may become increasingly stiff, but the pain does not usually get worse and may decrease.

Your shoulder muscles may start to waste away slightly because they are not being used. This stage lasts 4-12 months.

Stage three


Stage three is the 'thawing' phase. During this period, you will gradually regain some movement in your shoulder. The pain will begin to fade, although it may recur from time to time as the stiffness eases.
Although you may not regain full movement of your shoulder, you will be able to carry out many more tasks. Stage three can last from five months to many years.

What conditions can mimic a frozen shoulder?


Inflammation of the shoulder joint (arthritis) or the muscles around the shoulder and degenerative arthritis of the shoulder joint can cause swelling, pain, or stiffness of the joint that can mimic the range of motion limitation of a frozen shoulder.

Injury to individual tendons around the shoulder (tendons of the rotator cuff) can limit shoulder-joint range of motion but usually not in all directions. Often during the examination of a shoulder with tendon injury (tendinitis or tendon tear), the doctor is able to move the joint with the patient relaxed beyond the range that the patient can on their own.


How is a Frozen Shoulder (Adhesive Capsulitis) diagnosed?


A frozen shoulder is suggested during examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement. Underlying diseases involving the shoulder can be diagnosed with the history, examination, blood testing, and X-ray examination of the shoulder.

If necessary, the diagnosis can be confirmed when an X-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is called arthrography. The tissues of the shoulder can also be evaluated with an MRI scan.

What is the treatment for a Frozen Shoulder (Adhesive Capsulitis)?


The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy (physiotherapy). Without aggressive treatment, a frozen shoulder can be permanent.

Diligent physical therapy is often essential for recovery and can include ultrasound, electric stimulation, range-of-motion exercise maneuvers, stretching, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.

Sometimes a frozen shoulders is resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.

Surgical and other procedures


Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

  • Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
  • Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
  • Shoulder manipulation. In this procedure, you receive a general anesthetic so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
  • Surgery. If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

Can frozen shoulder be prevented?


Gentle, progressive range-of-motion exercises, stretching, and using your shoulder more may help prevent frozen shoulder.

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you've had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint.