Frozen shoulder

WHAT IT IS ?

Adhesive capsulitis (also known as Frozen shoulder) is a painful and disabling disorder of unclear cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain

CAUSES AND RISK FACTORS:

Risk factors for frozen shoulder include tonic seizures, diabetes mellitus, stroke, accidents, lung disease, connective tissue diseases, thyroid disease, and heart disease. People who suffer from adhesive capsulitis may have extreme difficulty concentrating, working, or performing daily life activities for extended periods of time. The condition tends to be self-limiting and usually resolves over time without surgery. Most people regain about 90% of shoulder motion over time.

In frozen shoulder, there is a lack of synovial fluid, which normally helps the shoulder joint, a ball and socket joint, move by lubricating the gap between the humerus (upper arm bone) and the socket in the shoulder blade. The shoulder capsule thickens, swells, and tightens due to bands of scar tissue (adhesions) that have formed inside the capsule. As a result, there is less room in the joint for the humerus, making movement of the shoulder stiff and painful. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder.

SIGNS AND SYMPTOMS :

Movement of the shoulder is severely restricted, with progressive loss of both active and passive range of motion. The condition is sometimes caused by injury, leading to lack of use due to pain, but also often arises spontaneously with no obvious preceding trigger factor (idiopathic frozen shoulder). Rheumatic disease progression and recent shoulder surgery can also cause a pattern of pain and limitation similar to frozen shoulder. Intermittent periods of use may cause inflammation.

One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is external rotation of the shoulder.

People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion, or if bumped. physical examination reveals limited shoulder movement. Frozen shoulder can be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder).

INVESTIGATIONS REQUIRED :

Adhesive capsulitis is primarily a clinical diagnosis, though imaging may be used to exclude other causes of shoulder pain and depict findings that increase confidence in clinical diagnosis. Arthrography is usually regarded as the gold standard for imaging diagnosis. Ultrasound and MRI may help in diagnosis by assessing thickening of the coracohumeral ligament. Both proximal and distal fibers of the ligament can be evaluated. Another ultrasound finding consistent with the clinical diagnosis of adhesive capsulitis is hypoechoic material surrounding the long head of the biceps brachii tendon at the rotator interval. In the painful stage, such hypoechoic material may demonstrate increased vascularity with Doppler ultrasound.

TREATMENT POSSIBLE :

Management of this disorder focuses on restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention. Treatment may continue for months, Medications frequently used include NSAIDs; corticosteroids are used in MOST cases through local injection which curtails the cycle . most patients get total relief by 1 OR 2 injections.

Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy. Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitis or rotator cuff tear may be needed.

REHABILITATION AND RECOVERY :

Patient is advised to move and lift the shoulder immediately after injection.

We follow a specific exercise protocol which makes the patient comfortable in 1 week and by 2-3 weeks patient is relatively pain free and maximum shoulder movement is regained