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Adhesive capsulitis (frozen shoulder syndrome)

Frozen shoulder syndrome is a disorder in which the capsule of the ball and socket joint (glenohumeral joint) becomes inflamed, painful, and eventually stiff. There tends to be a decrease in the synovial fluid in the glenohumeral joint. This leads to a decrease in movement, a thickening of the capsule, and formation of scar tissue within the capsule.

CAUSES: The cause of frozen shoulder is not well understood, but there is an increased rate in patients who have had to be immobilized for a period of time or have had a previous injury of the shoulder. Women over 40, for some reason, are the majority of frozen shoulder cases, but it can occur in men and less frequently in those under 40 years old. Risk factors for this may also include patients who have diabetes, both hypo and hyperthyroidism, heart disease or a history of stroke.

SIGNS/SYMPTOMS: There are 3 stages of frozen shoulder.

  1. Painful stage: Pain with movement of the shoulder. The pain may possibly be worse at night affecting sleep. There may also be some limited range of motion. The pain is usually dull in nature. This stage can last 6 weeks to 9 months.
  2. Frozen stage: The pain may start to decrease but the shoulder becomes stiff and diminishing range of motion is very obvious. Both active and passive ranges of motion are limited. This stage may last 4 to 9 months.
  3. Thawing stage: Range of motion of the shoulder begins to improve. This stage may last anywhere from 5 to 26 months. The recovery is a slow process.

DIAGNOSIS: The history of pain and physical exam can tell a lot about shoulder problems. Usually, imaging is not necessary to make a diagnosis of frozen shoulder. However, certain types of imaging may help to rule out other causes of shoulder pain.

TREATMENT: During the painful stage, controlling pain is the main concern. Ice, anti-inflammatories and pain relievers (both of them may be natural or synthetic) and cold laser help.  During the frozen stage, the primary focus when treating frozen shoulder is improving mobility. Physical therapy and massage therapy can help to loosen up the joint capsule. Heat before stretching can aid in loosening the capsule, however, icing afterwards is necessary to help minimize inflammation. Chiropractic adjustments can be integral in improving movement as well.

COMPLICATIONS: Frozen shoulder syndrome is usually self-limiting. This means that regardless of what is done, the problem tends to go away on its own. The problem is it could take several years for this to happen. Complications are more notable if there is an underlying condition such as diabetes, heart disease, or others mentioned above.

PROGNOSIS: Recovery from frozen shoulder syndrome may be long and frustrating. Physical therapy focusing on improving mobility can be very painful and arduous. In the event that conservative care is unsuccessful, surgery to break up adhesions may be used. Like all surgeries, this demands the need for rehabilitation to not only maintain mobility, but also increase muscle strength. Frozen shoulder tends to disrupt several aspects of daily life, including sleep since the pain can be worse at night. 

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