Frozen shoulder or adhesive capsulitis is a condition in which shoulder movements are restricted in almost all directions. It is a painful condition. It starts gradually.

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Causes

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Shoulder joint is a ball and a socket joint with a huge range of motion compared to any other joint in the body. It has got a thin capsule along with the ligaments which while holding it in place, will support full range of motion. When the capsule thickens and becomes tighter it causes the stiffness and pain. The exact reason is unknown in majority of these patients. However it is seen more frequently in certain groups of people

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• Diabetes Mellitus

• Thyroid disorders

• Parkinsonism

• Post injury

• Post-surgery

 

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Symptoms

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• Global restriction of range of movements. Loss of external rotation is one of the important signs in the assessment of this condition

• Pain. Day and night time pain

• Stiffness. Restricts the overhead activities

 

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3 Stages of Frozen shoulder

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• Freezing stage. All movements of the shoulder are painful and limited. This lasts for 3 to 9 months.

• Frozen stage. Pain may slightly improve, however the stiffness gets worse. This lasts for 6 to 12 months.

• Thawing stage. Shoulder movements improve to an extent, however it is common to see some residual terminal restriction of range of movement. This lasts for 6 to 24 months.

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Natural History (Progression of disease in the absence of treatment)

 

Although the pain component of Frozen shoulder may gradually resolve over the first 12 months, the residual stiffness and restriction of the range of the movements will persist in majority of patients even beyond 2 years in the absence of treatment for the Frozen shoulder.

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Prevention

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• Good control of diabetes.

• Proper management of thyroid disorders.

• Early mobilization post injury as feasible.

• Early mobilization post-surgery.

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Treatment Options

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Treatment modalities range from physiotherapy - exercise based treatment with or without steroid injection. In people with poor improvement with this, may need manipulation under anaesthesia. In neglected frozen shoulder cases, arthroscopic release of the frozen shoulder would be recommended.

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