Frozen shoulder

Read in Hindi

Stages
Symptoms
Causes And Risk Factors
Prevention
Diagnosis
Treatment
Lifestyle Management
Prognosis And Complications
Alternative Treatments

A frozen shoulder, also known as adhesive capsulitis, is a joint problem that causes stiffness, pain, and loss of motion in the shoulder. This may lead to a severe disability and cause prolonged pain if left untreated.

The reasons behind the frozen shoulder condition are unknown. However, it may occur because of immobilization of the shoulder for a long, long time due to injury, surgery, or illness. In many cases, the cause is obscure. However, with proper treatment, you can usually unfreeze the shoulder. The recovery takes time and patience.

The shoulder has a broader range of motion than any other part of the body. It is a ball-and-socket joint, which enables the shoulder to move forward or backwards and allows the arm to rotate and extend outward. The synovial fluid lubricates the joints and helps them to move smoothly. Various muscles and tendons stabilize the shoulder and control its movements. They are known as the rotator cuff. This elaborate architecture of soft tissue allows for the shoulder's flexibility, but it also makes it vulnerable to wear and tear and trauma.

Also Read

Anatomy of a frozen shoulder:

Usually, the head of the humerus moves smoothly in the glenoid cavity, a depression in the scapula. A shoulder is considered frozen when the capsule protecting the glenohumeral joint contracts and stiffens. Adhesions may also form between joint capsules and the head of the humerus.

Stages

Frozen shoulder can have typically three stages:

Phase 1 The painful freezing phase:

This phase typically lasts from 2 to 9 months. Limitation of movement and stiffness accompany the pain, which is typically worse at night and may cause the inability to lie on the affected side.

Phase 2, The frozen stiff phase:

This phase lasts from 4 to 12 months. The pain on the frozen side eases, but the movement can become more restricted. All the movements of the shoulder get affected. Studies show that the movement most severely affected is usually the outward rotation of the arm, which you would need to hold a glass of water or a tray of food.

Phase 3, The thawing recovery phase:

This phase lasts from 1 to 3 years. In this phase, the pain and stiffness may gradually decrease, and normal movement may return.

Symptoms

The symptoms occur in stages, as mentioned above. However, you can experience one or more of these over time:

Pain in the shoulder

Limitation to the shoulder’s movement

Not being able to function independently while doing everyday tasks like dressing up, combing hair or getting ready.

Causes And Risk Factors

The causes and risk factors of the Frozen Shoulder are:

Causes

Frozen shoulder is commonly caused by inflammation of the joints. The joints are held together by a capsule-shaped tissue. Typically, this capsule has folds that can expand and contract with the arm’s movements. In the case of a frozen shoulder, this capsule becomes inflamed, and scarring takes place. These scars are known as adhesions. The folds of the capsules further become hard and tight, restricting the shoulder movements. The joints' movement becomes painful. This condition is called adhesive capsulitis, also known as frozen shoulder.

It is not known what exactly resides in this condition. Immobilization of the shoulder joint for a long time due to an injury can lead to this condition.

Risk Factors

Risk factors for frozen shoulder include:

Age: Adults between the age of 40 and 60 are more prone to developing frozen shoulders.

Gender: More commonly diagnosed in women than in men.

Recent shoulder injury: Any shoulder injury or surgery that leads to immobilization of the shoulder can lead to a frozen shoulder.

Diabetes: 10-20% of diabetic individuals develop frozen shoulders.

Other health conditions: Stroke, hypothyroidism, hyperthyroidism, Parkinson’s disease, and heart disease can lead to frozen shoulder. Stroke is listed as a risk factor as it may cause limitations to the movement of the shoulder.

Prevention

After surgery, the patient is made to go through a gentle range of motion exercises. This progressively stretches the joint capsule and thus maintains the shoulder movements and prevents the frozen shoulder.

Experts still cannot figure out the reason for the frozen shoulder and think medication may not stop it. However, certain exercises may help. Be patient and follow your doctor's advice.

Diagnosis

Physical examination:

After taking a brief history of the symptoms, the doctor will examine the shoulder.

The doctor will check the shoulder’s elasticity/restrictiveness by moving it in different directions. When the doctor moves the shoulder, the range of motion is known to be the "passive range of motion". When the patient moves his/her shoulder independently, it is known as the “active range of motion”. Both active and passive range of motion is limited in the case of people having frozen shoulders.

Imaging tests:

X- Rays- These reveal dense structures such as bones. X-rays may also point toward the underlying problems in the patient’s shoulders, like arthritis.

Magnetic resonance imaging and ultrasound help to see the soft tissues more clearly and precisely.

Treatment

The frozen shoulder tends to get better with time, although it takes up to three years for complete recovery. The focus of the treatment is to control the pain and restore motion and strength in the shoulder through physical therapy.

Nonsurgical treatment

Anti-inflammatory medicine: Drugs like aspirin and ibuprofen reduce pain and swelling.

Steroid injections: Cortisone is injected directly into the shoulder joints to decrease inflammation.

Hydro dilation: In this procedure, the doctor will inject a large volume of sterile fluid into the shoulder joint, which will help the joint’s capsule expand and stretch.

Physical therapy: Some exercises will help the restoration of motion. They can do these exercises with the help of a physiotherapist or family members. The therapy includes stretching and movement exercises, which will help the mobility of the shoulders. Some of these exercises are

External rotation-passive stretch: Stand with the support of a doorway and bend your affected arm to 90° to reach the doorknob. Keep your hand in place and rotate your body hold for 30 seconds, relax and repeat.

Forward flexion-supine position: Lie on your back, keeping your legs straight, use your unaffected arm and lift your affected arm overhead until you feel the stretch. Stay in this position for 15 seconds and slowly lower to the starting position. Relax and repeat.

Crossover arm stretch: Pull one of your arms across your chest just below your chin as far as possible, which will not cause pain. Hold it for 30 seconds, relax and repeat.

Lifestyle Management

Some lifestyle changes that will help to improve the pain, and swelling of the frozen shoulder are:

Cold compress: Cold compress therapy helps control inflammation and improves blood supply to the affected joints. The cold compress can be done at home by taking ice cubes, placing them in a plastic bag, wrapping this in a thin towel, and placing them on the affected area for 10-20 mins daily.

Massage: Gently massaging your shoulder joint helps in reducing short-term and long-term pain. You can massage the affected area with mustard oil, sesame oil, or coconut oil.

Hot compress: Heat therapy is effective for treating tightness and contracture of muscles. It improves the blood supply. You can use a rubber hot water bag or take a hot shower for 10-20 mins.

Using shoulder pillow: The shoulder pillow helps avoid pressure on the shoulder and encourages blood flow to the tissue.

A healthy diet: A healthy diet with a blend of vitamins and minerals can help your injury recover faster. You must include carbohydrates, proteins, omega 3 fatty acids, vitamin C, zinc, vitamin D3, and calcium through supplements or dietary sources.

Prognosis And Complications

Prognosis

Pain relievers and shoulder exercises are often helpful in restoring the motion and function of the shoulder within a year or even less. The completely untreated shoulder also tends to get better on its own but takes a much longer time. Complete or nearly complete recovery is seen after two years.

Complications

The complications associated with frozen shoulder include:

Residual pain

Residual stiffness

Fracture of humerus

Rupture of biceps

Alternative Treatments

Alternative treatment includes surgical interventions like:
Anesthesia accompanied manipulation in which your physician will move the shoulder’s placement that will release the tightening.
Shoulder arthroscopy is a procedure where your doctor will cut the tightened portions of the shoulder surgically.

References.

Health Harvard. How to release a frozen shoulder. [Internet] [Updated on: March 19, 2019] Available at: https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder

Patient info. Frozen shoulder. [Internet] [Updated on: Dec 24, 2018] Available at: https://patient.info/bones-joints-muscles/frozen-shoulder-leaflet

Medanta. Frozen shoulder. [Internet] Available at: https://www.medanta.org/orthopaedic-hospital/disease/frozen-shoulder/
Hopkins Medicine. Frozen Shoulder. [Internet] ]https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder Accessed on: 11/05/2021
Cleveland Clinic. Frozen Shoulder. [Internet] [Updated on: 1/19/2019] Available at: https://my.clevelandclinic.org/health/diseases/15359-frozen-shoulder

Stanford healthcare. Frozen shoulder. [Internet] Available at: https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/frozen-shoulder/prevention.html#:~:text=Can%20frozen%20shoulder%20be%20prevented,be%20possible%20to%20prevent%20these.

Orthoinfo. Frozen Shoulder. [Internet] Available at: https://orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder/ Accessed on: 11/05/2021

Perfect Anatomy. How to relieve shoulder pain remedies.[ Internet] Available at: https://perfectanatomy.org/blog/2019/7/30/how-to-relieve-shoulder-pain-8-remedies-to-try-at-home
NCBI. Frozen shoulder. [Journal] [Updated on: September 3,2020] Available at: https://www.ncbi.nlm.nih.gov/books/NBK482162/