| n shoulder – the medical term is | | | | (movement without assistance) and also passive |
| “adhesive capsulitis”- is a common | | | | range of motion (movement with assistance). The loss |
| ailment, estimated to affect between 2 percent and 3 | | | | of both active and passive movement and the |
| percent of the population. | | | | presence of generalized shoulder tightness and pain |
| Diabetics are at higher risk; up to 20 percent get it. For | | | | are strong indicators of frozen shoulder. |
| this reason, frozen shoulder may have an autoimmune | | | | Imaging procedures such as X-ray or magnetic |
| component responsible for its development. Trauma | | | | resonance imaging (MRI) scan of the shoulder should |
| sometimes precedes a frozen shoulder. People with | | | | be done to exclude other structural shoulder problems. |
| other health conditions, including heart disease, lung | | | | Treatment of frozen shoulder treatment consists of |
| disease and hyperthyroidism, also may have an | | | | controlling shoulder pain and preserving as well as |
| increased risk of developing frozen shoulder. | | | | improving the range of motion in the shoulder as much |
| Seventy percent of patients are middle-aged women | | | | as possible to allow performance of activities of daily |
| and some specialists feel there may be hormonal | | | | living. |
| factors involved. | | | | Physical therapy is helpful in showing patients how to |
| The condition characterized by stiffness and pain in | | | | maintain as much mobility as possible. Stretching |
| the shoulder joint. At the beginning there can be pain | | | | exercises, while painful, are important in establishing |
| and some limitation of range of motion in the shoulder. | | | | normal range of motion. |
| With worsening, the shoulder's range of motion | | | | Patients should continue to use the involved shoulder in |
| becomes markedly reduced. | | | | as many daily life activities as possible within the limits |
| Frozen shoulder usually affects one shoulder at a time, | | | | of pain. |
| although some people can develop frozen shoulder in | | | | A home program of range of motion exercises won't |
| the opposite shoulder. | | | | alleviate the symptoms of frozen shoulder. However, it |
| Frozen shoulder typically develops slowly, and in three | | | | can help restore enough shoulder motion to help a |
| stages. Each of these stages can last several weeks | | | | person resume their everyday activities. |
| to months: | | | | Other therapies that may be useful include: |
| • Painful stage. During this stage, pain occurs | | | | • Non-steroidal anti-inflammatory drugs |
| with any movement of the shoulder and the range of | | | | (NSAIDs). These medications can help to relieve pain |
| motion starts to become limited. | | | | and inflammation. |
| • Frozen stage. Pain may begin to diminish | | | | • Heat or cold. Application of heat or cold to |
| during this stage. However, the shoulder becomes | | | | the shoulder also can relieve pain. Topical agents may |
| stiffer and the range of motion becomes dramatically | | | | also be useful. |
| reduced. | | | | • Glucocorticoids (“steroids”). |
| • Thawing stage. During the thawing stage, the | | | | Injecting these anti-inflammatory compounds into the |
| range of motion in the shoulder begins to improve. | | | | shoulder can decrease pain and shorten symptoms |
| The pain is often worse at night and disrupts sleep. | | | | duration during the initial painful phase. Glucocorticoids |
| The exact cause of frozen shoulder is unknown. As | | | | need to be injected into both the glenohumeral joint |
| mentioned earlier, It can occur after an injury to the | | | | (joint between the humerus and scapula) as well as |
| shoulder or after prolonged immobilization of the | | | | the subacromial bursa, the area that sits at the top of |
| shoulder, such as after surgery or an arm fracture. | | | | the humerus where it interacts with the clavicle |
| The shoulder is a ball-and-socket joint. The end of the | | | | (collarbone). The reason is that the adhesions in a |
| humerus (upper arm bone) is shaped like a ball and fits | | | | frozen shoulder prevent the spread of the steroid |
| into a shallow cup in the scapula (shoulder blade). | | | | medicine around the joint so the steroid needs to be |
| Tough connective tissue forms a shoulder capsule that | | | | injected into the two major areas where the |
| surrounds the joint. | | | | adhesions seem to cause the biggest problem. |
| As frozen shoulder develops, the shoulder capsule | | | | However too many repeated steroid injections aren't |
| becomes inflamed. The inflammation causes adhesions | | | | recommended. |
| (bands of stringy tissue) to develop within the shoulder | | | | • Surgery. In a small number of cases, |
| joint. Synovial fluid, the normal lubricating fluid within the | | | | especially if symptoms don't improve despite other |
| joint , decreases in volume. | | | | measures, surgery may be an option to remove |
| As a result, pain and loss of range of motion occur. | | | | adhesions and other scar tissue that has accumulated |
| Mobility can decrease so much that performing simple | | | | inside the shoulder joint. Doctors usually perform this |
| activities of daily living such as dressing and undressing, | | | | surgery with an arthroscope (a small telescope) that is |
| brushing hair, and reaching up to shelves are difficult. | | | | inserted through a small incision. |
| What are known risk factors for frozen shoulder? A | | | | • Shoulder manipulation. In a few people, if |
| few are: | | | | severe stiffness persists, manipulation of the shoulder |
| • Age. People over the age of 40 are more | | | | while the patient is under general anesthesia can |
| likely to experience frozen shoulder. | | | | mobilize the shoulder. The danger is that occasionally |
| • Diabetes and other systemic diseases. | | | | the arm can break during manipulation. |
| Frozen shoulder is more common in people with | | | | There are still some physicians who tell a patient to let |
| hyperthyroidism (overactive thyroid), hypothyroidism | | | | the shoulder alone and bear with it since the majority |
| (underactive thyroid), cardiovascular disease and | | | | of patients with adhesive capsulitis recover |
| Parkinson's disease. | | | | spontaneously over a two year period of time. I |
| • Immobility. People who have experienced | | | | personally believe that is not the correct approach |
| prolonged immobility of their shoulder as a result of | | | | since the pain during the acute phase can be so |
| trauma, overuse injuries or surgery. | | | | intense and the reduced mobility during the |
| The primary method for making the diagnosis of | | | | “frozen” stage can be so debilitating. |
| frozen shoulder is history and physical examination. | | | | Aggressive treatment is, in my opinion, the better |
| The physician will assess both active range of motion | | | | approach. |