Overview:
Frozen shoulder, clinically known as adhesive capsulitis, is a painful and restrictive condition characterised by the gradual loss of shoulder mobility and increased stiffness. It typically develops gradually over time and can significantly impact daily activities and quality of life.
Anatomy:
The shoulder joint is a complex structure consisting of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). Surrounding the joint is a capsule of connective tissue that encloses the joint and holds its components together. In the frozen shoulder, this capsule becomes thickened and inflamed, leading to adhesions and reduced joint space.
Causes:
The exact cause of frozen shoulder is not always clear, but several factors may contribute to its development, including:
- Injury or trauma: Previous shoulder injuries, surgeries, or prolonged immobilisation can trigger inflammation and scar tissue formation within the joint capsule.
- Medical conditions: Certain medical conditions such as diabetes, thyroid disorders, heart disease, or autoimmune diseases may increase the risk of developing frozen shoulders.
- Immobility: Prolonged periods of immobility or lack of use, such as during recovery from surgery or due to shoulder pain, can lead to joint stiffness and adhesion formation.
Symptoms:
Symptoms of frozen shoulder typically progress through three stages:
- Freezing stage: Gradual onset of shoulder pain and stiffness, often worsening over time. Shoulder movement becomes limited, especially external rotation and abduction.
- Frozen stage: Persistent shoulder stiffness and restricted range of motion, making daily activities challenging. Pain may decrease but stiffness remains.
- Thawing stage: Gradual improvement in shoulder mobility and reduction in stiffness. Range of motion gradually returns to normal, but recovery may take several months to years.
Diagnosis:
Diagnosing frozen shoulders involves a comprehensive evaluation of medical history, symptoms, and physical examination. Imaging studies such as X-rays or MRI may be ordered to rule out other shoulder conditions and assess the extent of joint involvement.
Treatment:
Treatment for frozen shoulder aims to alleviate pain, improve shoulder mobility, and restore function. Common approaches include:
- Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, or pain-relieving medications may help reduce inflammation and alleviate discomfort.
- Physical therapy: Gentle stretching exercises, manual therapy techniques, and a range of motion exercises prescribed by a physiotherapist can help improve shoulder flexibility and mobility.
- Joint mobilisation: Techniques such as joint mobilisation or manipulation performed by a qualified healthcare provider can help break up adhesions and improve joint mobility.
- Hydrodilatation: In some cases, a procedure called hydrodilatation may be performed, where a mixture of saline solution and corticosteroids is injected into the shoulder joint to stretch the capsule and improve mobility.
- Surgical intervention: In severe or refractory cases of frozen shoulder, arthroscopic surgery may be considered to release tight ligaments and remove adhesions within the joint capsule.
Prevention:
While the exact cause of frozen shoulder may not always be preventable, certain measures may help reduce the risk of developing the condition or minimise its impact:
- Maintain shoulder mobility: Regular shoulder exercises and stretching can help maintain joint flexibility and prevent stiffness.
- Avoid prolonged immobilisation: If recovering from shoulder surgery or injury, work with a healthcare professional to implement a gradual rehabilitation program to prevent joint stiffness.
- Manage underlying conditions: Proper management of medical conditions such as diabetes or thyroid disorders may help reduce the risk of developing frozen shoulders.
Outlook:
The prognosis for frozen shoulder varies depending on the severity of the condition, the effectiveness of treatment interventions, and individual factors such as age and overall health. While recovery may be slow and gradual, most individuals experience significant improvement in shoulder mobility and function with appropriate treatment and rehabilitation. It is essential to work closely with healthcare professionals to develop a tailored treatment plan and optimise long-term outcomes.
