Frozen Shoulder: Factors, Stages, Treatments

Stiffness around the shoulder joint, debilitating pain and limited range of movement in the shoulder are all symptoms of “Frozen Shoulder” or “Adhesive Capsulitis”. The onset of this disorder is very slow and to regain the use of the shoulder, free of pain is also a slow process.

Composition of the Shoulder

The shoulder comprises of a ball and socket joint. Three bones conjoin to form this joint –

1. The shoulder blade or scapula

2. The collarbone or clavicle

3. The upper arm or humerus

The head of the humerus fits into the shallow socket of the shoulder joint, and the connective tissue also known as the shoulder capsule, envelops the joint. Synovial fluid present in the shoulder capsule, lubricates the shoulder capsule and the joint and thereby enables the shoulder to move more easily. 

When the connective tissue in the shoulder capsule becomes rigid due to the formation of tight bands of tissue or adhesions, with a simultaneous decrease in the level of synovial fluid, it causes stiffness and limits the range of motion, of the shoulder. This condition is referred to as “Frozen Shoulder”.

Stages of Adhesive Capsulitis

• First stage or Freezing Stage – it is a slow process and with time the pain increases and becomes worse, consequently leading to loss of motion in the shoulder joint. It takes anywhere from 6 weeks to 9 months for the onset of a freezing shoulder
• In stage two (4 months to 6 months), or the Frozen state, the stiffness in the joint continues, however, the pain may subside slightly. During this stage, daily activities involving the movement of the shoulder will be very difficult
• In the Thawing or third stage, the motion in the shoulder begins to improve, but to regain complete or near to normal motion in the shoulder, it may be anywhere from 6 months to 3 years

Factors

• Affects people in the age group between 40 – 70 years
• People with chronic ailments like diabetes or suffering from stroke, hypothyroidism, hyperthyroidism, Cardiac and Parkinson’s diseases
• Can be caused by surgery, such as mastectomy, or due to a fracture or any other injury

Diagnoses

The doctor will either conduct a physical examination or will request for an x-ray or MRI to rule out other causes or injuries. The Orthopedic Surgeon may also request an Ultrasound if suspecting a thickening of the broad ligament (coracohumeral ligament), which helps strengthen the capsule in the shoulder joint. Thickening of the coracohumeral ligament or CHL is another suggestive factor of adhesive capsulitis or frozen shoulder.

Treatments

The minimum time taken for a frozen shoulder to regain its normal range of motion or near normalcy, could be 3 years, if left untreated.   

The aim of treating a frozen shoulder is to curb the pain and to improve the range of motion in the shoulder and to strengthen the shoulder.

Non-Surgical Treatments

Include:

• Prescription of anti-inflammatory, non-steroidal drugs such as analgesics or ibuprofen
• Injecting Cortisone, a steroidal medication, directly into the shoulder joint
• Physiotherapy and heat treatment – In some cases heat treatment may be employed to loosen the shoulder joint, before performing the stretching and range of motion exercises, which are performed under the supervision of a physiotherapist 

Surgical Treatment

When a patient diagnosed with frozen shoulder disorder, fails to respond to any of the non-surgical treatments, listed above, then surgery will be considered. 

The aim of performing surgery is to remove the stiffness from the joint and to stretch the connective tissue. This is done either by manipulation under anesthesia (MUA) or through shoulder arthroscopy. 

MUA – This procedure is performed by the Orthopedic Surgeon. Anesthesia is administrated and while the patient is under, the Orthopedic Surgeon will manipulate the shoulder joint to move, causing the capsule and scar tissue to either tear or stretch, consequently releasing the stiffness and increasing the range of motion.

Surgical Capsular Release or Shoulder Arthroscopy – After anesthesia has been administrated, the Orthopedic Surgeon will make 2 or 3 tiny, keyhole incisions into the afflicted shoulder. An arthroscope (camera measuring 3 and half millimeter) is inserted into one of the incisions. The images from the camera are projected onto a computer screen. Through the other two incisions, microsurgical instruments are inserted to surgically release the frozen shoulder.

Sometimes, the orthopedic surgeon may use both the manipulation and arthroscopy procedures simultaneously, to get the maximum outcomes. 

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