Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. The onset of the disease is often unexplained, leading to a significant limitation in movement. This condition affects the capsule surrounding the shoulder joint, causing a thickening and scarring of the tissues, resulting in a loss of elasticity and impairment of certain anatomical structures.
Anatomical Impact of Frozen Shoulder
Under normal circumstances, the shoulder joint allows for a wide range of movements due to its unique anatomical structure. However, when a person develops frozen shoulder, the capsule surrounding the joint rigidifies and forms adhesions. This stiffness results in a decrease in both active and passive movement, meaning this limitation is present when the patient attempts to move the arm actively and when it is moved by a medical professional.
This decrease in passive movement is a distinguishing characteristic of frozen shoulder, setting it apart from other shoulder-related conditions such as rotator cuff injury. The limitation in joint movement is observed in all planes of movement, especially in external rotation.
Causes of Frozen Shoulder
While most cases of frozen shoulder occur without an apparent cause, certain risk factors have been identified. These include:
Age The condition is more common in individuals aged between 40 and 60.
Gender Women are more likely to develop adhesive capsulitis, with a double to triple risk compared to men.
Conditions such as diabetes and thyroid dysfunction Patients with these conditions are more at risk than the general population.
Other systemic diseases Cardiovascular diseases, Parkinson's disease, hypercholesterolemia, and arthritis, have been linked to an increased risk of developing frozen shoulder.
Previous history of shoulder pain and immobility Patients who have suffered a shoulder injury are more likely to develop frozen shoulder, especially if the injury was followed by a lengthy period of immobilization not accompanied by a suitable rehabilitation program.
Prolonged use of certain medications
Symptoms of Frozen Shoulder
The most significant symptom of frozen shoulder is the limitation of movement associated with pain. Other symptoms include:
Difficulty performing normal daily tasks such as shaving, fastening a bra, or brushing hair due to pain and limited movement.
Pain intensifying during night rest, especially when sleeping on the affected shoulder.
The disease often affects the non-dominant limb and in rare cases, both shoulders simultaneously.
The progression of the disease can be divided into three distinct phases:
Cooling phase This is the initial and most painful phase of the disease. The pain worsens over time, leading to increasing limitation in shoulder use. This phase generally lasts 6-12 weeks.
Freezing phase Joint stiffness increases, while the pain tends to ease. This phase can last 4-6 months.
Thawing phase This phase is characterized by a gradual improvement of the condition and can last more than a year.
Diagnosis of Frozen Shoulder
The diagnosis of frozen shoulder is typically based on the patient's symptoms and medical history, along with specific tests. Additional diagnostic tests may include X-rays to rule out other specific lesions or signs of arthritis. Blood tests may also be conducted to evaluate the presence of predisposing conditions such as hypercholesterolemia, diabetes, and thyroid dysfunction.
Treatment and Rehabilitation for Frozen Shoulder
The primary goals of treatment for frozen shoulder are to reduce pain and regain lost mobility. The treatment often includes:
Stretching and mobilization exercises to improve the range of motion and minimize the loss of muscle tissue.
Applying heat to loosen the joint blockage through increased local vasodilation.
Use of physical therapies like ultrasound, laser therapy, and TENS to speed up recovery.
Local cortisone injections to reduce pain in the initial stages.
Use of complementary and alternative medicine like osteopathy and acupuncture.
Exercises for Frozen Shoulder
Certain exercises can help increase shoulder mobility and improve the elasticity of the muscles and tendons that make up the rotator cuff. These exercises include:
Pendulum Exercise This exercise involves swinging the affected arm gently in different directions while keeping the muscles as relaxed as possible.
Internal Rotation Exercise This exercise involves lifting a rod or elastic band behind your back using the healthy limb.
Shoulder Extension Exercise This exercise involves pushing a rod backwards away from the body while keeping the torso straight.
Stretching of the Shoulder Muscles This exercise involves bringing the inside of the elbow of the affected limb closer to the shoulder of the opposite arm.
It is important to consult with a medical professional before starting these exercises. Avoid sudden movements and excessive stretching, and stop exercising immediately if shoulder pain occurs.
In certain cases where treatments are ineffective, surgery may be considered. This could involve manipulation under anesthesia to break up the adhesions causing the frozen shoulder, or a capsular release surgery performed through shoulder arthroscopy. After surgery, a passive micromobilization program associated with physical therapy should be immediately started to prevent the recurrence of the disease.
