Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition in which the shoulder joint becomes stiff and painful, making it difficult to move. It is more common in people over the age of 40 and in those with diabetes.

 

Anatomy:

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The shoulder joint is a ball-and-socket joint that is formed by the head of the humerus (upper arm bone) and the glenoid cavity of the scapula (shoulder blade). The joint is surrounded by a capsule of connective tissue that helps to hold the bones in place and allows for movement. The capsule is lined with a thin layer of tissue called the synovium, which produces fluid to lubricate the joint.

 

Pathoanatomy:

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The exact cause of frozen shoulder is not known, but it is thought to be due to inflammation and thickening of the capsule and surrounding tissues. This can lead to the formation of adhesions or scar tissue, which can restrict movement of the joint. In some cases, the condition may be triggered by an injury or surgery to the shoulder.

 

Mechanism of injury:

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The mechanism of injury is not well understood, but it is believed that frozen shoulder may develop as a result of inflammation and thickening of the joint capsule and surrounding tissues. This can lead to the formation of adhesions or scar tissue, which can restrict movement of the joint.

 

Symptoms:

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The main symptom of frozen shoulder is pain and stiffness in the shoulder joint. The pain may be dull and achy, and may be worse at night. The stiffness may make it difficult to perform simple tasks such as reaching overhead or behind the back. The condition typically develops slowly over time and can last for several months to several years.

 

Phases of frozen shoulder:

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Frozen shoulder typically progresses through three phases, each of which can last several months:

 

1. Freezing: The shoulder becomes increasingly stiff and painful, making it difficult to move. This phase may last 6-12 weeks.

 

2. Frozen: The shoulder remains stiff, but the pain may begin to subside. This phase may last 4-6 months.

 

3. Thawing: The shoulder gradually regains range of motion, and pain subsides. This phase may last 6-12 months.

 

Treatment options:

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Treatment for frozen shoulder typically involves a combination of physical therapy, medication, and in some cases, surgery.

 

Non-operative management:

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Physical therapy is often the first line of treatment for frozen shoulder. This may include exercises to improve range of motion and flexibility, as well as stretches to help relieve pain and stiffness. Anti-inflammatory medications such as ibuprofen or naproxen may also be prescribed to help reduce pain and inflammation.

 

Operative management:

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In cases where non-operative treatment is not effective, surgery may be necessary. This may involve arthroscopic surgery to remove scar tissue and adhesions from the joint, or manipulation under anesthesia to help break up the adhesions and improve range of motion.

 

Recovery time:

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Recovery time for frozen shoulder can vary depending on the severity of the condition and the effectiveness of treatment. Mild cases may resolve in a few months with non-operative treatment, while more severe cases may take a year or more to fully resolve. Recovery time after surgery may also vary, but most patients can expect to regain significant range of motion within a few weeks to a few months.