Frozen Shoulder

Frozen shoulder is the common name for adhesive capsulitis. It causes restricted painful movement of the shoulder. The reason for this is severe inflammation of the capsule of the shoulder due to which it becomes less elastic, thick and shrunken, just like scar tissue but painful. As a result, your shoulder joint doesn’t have enough space to rotate properly. Common symptoms include swelling, pain, and stiffness. It is more common in the age group of 30 to 60 and in diabetics.

Symptoms

Pain and restricted movement are the most common symptoms. Moving the shoulder less and less increases its stiffness. Slowly activities of daily living and sleep get disturbed. Simple routine activities like changing clothes, combing hair get difficult.

Causes

People with hormonal imbalance, diabetes mellitus, or a weak immune system, may be prone to joint inflammation. A long period of not moving the joint due to an injury, illness, or surgery also increases the chances of inflammation and adhesions and capsulitis. In serious cases, scar tissue may form. This significantly restricts your range of motion.

Who Is At Risk For A Frozen Shoulder?

The condition is more likely to occur in middle age and is more common in women.

If you have diabetes, your risk for the condition is three times greater.

Others at risk include:

  • people wearing an arm pouch, shoulder immobiliser or shoulder sling for a long period after an injury or surgery
  • people with thyroid disorders

How Is A Frozen Shoulder Diagnosed?

If you have pain and restricted range of movement , you should consult a shoulder specialist.

Dr Ahmed usually after a proper history ,would examine your shoulder for tenderness, any atrophy, range of movement. Many special tests are done to ascertain the status of the rotator cuff. Most of the times it is a diagnosis of exclusion.

X-rays will be advised to look for arthritis, bony spurs under the acromion, and acromiohumeral distance.

An MRI is advised only when conservative therapy is not working even after a month. This is done to rule out any associated pathologies like rotator cuff tears.

Medications

To treat the pain and reduce your joint inflammation, Dr Ahmed may recommend an anti- inflammatory medication like ibuprofen , Diclofenac etc.Some medicines which reduce the tightness of the capsule are also advised.It is also very important for Diabetic patients to keep their blood sugar levels under good control.

If medications and physical therapy are unable to improve the symptoms then an injection of steroid in the joint is also sometimes advocated. However physical therapy remains the mainstay of treatment even after that.

Placing an ice pack on your shoulder for 15 minutes at a time several times per day can help to decrease pain. Most people with a frozen shoulder can improve their condition without surgery.

Ultrasound guided injections are being used very commonly now for precisely locating the instillation of drug and better outcomes.

How Is A Frozen Shoulder Treated?

Physical Therapy

Dr Ahmed believes that good physiotherapy is the only treatment for this condition. The aim is to stretch your shoulder capsule and regain the lost motion. It can take anywhere from a few weeks to months to see progress. If you don’t see progress after six weeks of intense, daily exercises, other options need to be considered.

Surgery

If physical therapy doesn’t improve your condition, surgery is an option. At our facility, 2 out of 100 patients require surgery.

From a surgical standpoint, your options are to manipulate the shoulder and put it through a full range of motion under a general anesthetic to help break up any adhesions. Another option is arthroscopic surgery.

Dr Ahmed believes that manipulation under anaesthesia is a very risky procedure as the chances of inadvertently breaking the bone and causing fractures is very high.

Hence it is advised that an arthroscopic surgery is performed in these situations.This type of surgery involves making a small cut in your shoulder and using a camera called an “arthroscope” to remove scar tissue or release it. This allows the shoulder to recover its lost motion. If your frozen shoulder is the result of an injury, surgery is usually more successful if it’s performed within a few weeks of the injury.

Surgery is usually done on a day care basis. Stitches are removed after 12 days. Postoperative physical therapy is usually required in all patients. Many patients have their full range of movement back within 2 to 3 months.

Any Surgery has associated risks, so talk with your doctor before deciding on any procedure.