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Frozen shoulder or “adhesive capsulitis”, is of unknown origin, mostly affecting 40-60 year olds. It causes severe pain and stiffness of the shoulder and is thought to be of autoimmune in nature, triggered by factors such as illness, disease, inactivity, injury or trauma. The shoulder capsule is a connective tissue structure surrounding or “encapsulating” the shoulder joint. Frozen shoulder causes swelling, thickening and tightening of the shoulder capsule with inflammation and scarring.
There are 3 stages of frozen shoulder:
- The freezing (red) stage.
- The frozen (pink) stage.
- The thawing (white) stage.
Each stage may be endured for 6 months or more before entering the next stage.
Frozen shoulder may exhibit the following symptoms:
- Progressive loss of active and passive movement of the shoulder.
- Inflammation and swelling.
- Strong pain at rest and made worse by movement.
- Night pain and loss of sleep.
- Depression and helplessness.
The cause of the frozen shoulder is unclear. Frozen shoulder may arise soon after an obvious shoulder injury, but it may also arise spontaneously with no apparent reason or trigger factor as in the case of idiopathic frozen shoulder.
Major Shoulder Injury
Major shoulder injuries such as a fractured broken shoulder, dislocated shoulder and rotator cuff tears may cause the onset of frozen shoulder as the body reacts to trauma.
Auto-Immune Trigger Factors
Frozen shoulder may be of autoimmune nature, which is thought to be brought about by trigger factors such as autoimmune disease, connective tissue disease, lung disease, heart disease, thyroid disease, diabetes, cervical cancer, shoulder injury, surgery, long periods of inactivity. Diabetic women aged 40-60 years old have the highest rate of frozen shoulder.
To diagnose frozen shoulder the following will be taken into consideration:
- Nature of the injury (sports, work, accident, overuse etc).
- Cause of the injury (impact, collision, fall, repetitive/slow onset).
- Context of the suffering (age, return to sport, work, impact on daily living).
- Perform a physical examination to ascertain pain and range of movement.
- Perform specialised radiology to confirm a diagnosis.
Pain measure, how severe is your shoulder pain (scale of 1-10), and for how long have you suffered pain? Stage 1 lasts between 2-10 months and is the strongest pain stage of the condition.
In Stage 2 of the condition, pain begins to subside, but shoulder stiffness increases where neither you nor your doctor gets much movement out of your shoulder. This stage may last between 4- 10 months.
In stage 3, both pain and stiffness begin to subside. This stage may last between 5-25 months.
Frozen shoulder is an extremely painful condition. Treatment begins with a thorough diagnosis to understand the severity of the condition in the context of your age, your sport, your work and your life to understand what is important to you about your recovery.
Depending on the stage of your frozen shoulder condition, there are a number of treatments that may help you.
In the freezing stage of a frozen shoulder, the treatment goal is pain management. Your doctor can prescribe you appropriate medication which is safe and specific to your health and physiotherapy treatment can also help dissipate pain and maintain pain-free movement.
In the frozen stage of a frozen shoulder, the treatment goal is pain management and gentle movement. Your doctor can monitor your pain medication and your physiotherapist can introduce gentle stretching of the shoulder joint.
In the thawing stage of a frozen shoulder, the treatment goal is regaining movement and returning to living. Your doctor will monitor and start reducing your pain medication and your physio will introduce more aggressive stretching and functional exercises for your shoulder.
In most cases, frozen shoulder conditions will get better within 12-18 months.
If non-surgical treatment fails, Dr Gupta may use the following surgical treatment for frozen shoulder; MUH or manipulation under anaesthetic is a non-invasive procedure under anaesthetic to help break down scar tissue without associated pain, a capsular release can also be performed, this is a keyhole surgical procedure releasing scar tissue and the tight shoulder capsule.
Surgery is indicated in only a small number of candidates who have extreme suffering and loss of shoulder movement. The goal of surgery is to break down scar tissue that is too stubborn or too painful to respond to vigorous stretching.
Post Operative Rehabilitation
You will achieve the best surgical outcome if you follow up surgery with a matching course of rehabilitation. Following surgery, Dr Gupta will outline the most appropriate rehabilitation protocol for your physiotherapist to follow and communicate with your healthcare team to ensure that you receive the best post-operative treatment.