Adhesive shoulder capsulitis, which used to be called frozen shoulder or frozen shoulder, is also called “fifty shoulder” because of its high incidence around the age of 50, and is more common in middle-aged and elderly people. In adhesive capsulitis, the joint capsule becomes thickened and tightened, and the ligaments become contracted and stiffened, a condition called adhesions. In many cases, the lubricating fluid in the joint also decreases, and the most obvious feature is that you cannot move your shoulder either by yourself or with the help of others.
There are three general stages.
Freezing phase During the “freezing” phase, your shoulder will slowly become more and more painful. As the pain increases, the range of motion of the shoulder becomes less and less. This phase usually lasts from 6 weeks to 9 months.
During the freezing phase, the pain may improve, but the shoulder remains stiff. During the “freezing” phase, which lasts from 4 to 6 months, daily activities will be very limited.
During the “thawing” phase, shoulder movement will slowly improve. Full return to normal or near normal motion and strength usually takes 6 months to 2 years. The causes of adhesive capsulitis are not well understood and there is no clear occupational association, but there are several factors that may make you more susceptible to the disease.
Diabetic shoulder arthritis often occurs in people with diabetes, affecting roughly 10 to 20 percent of people with diabetes, and the cause is not clear.
Some other diseases associated with shoulder arthritis include hypothyroidism, hyperthyroidism, Parkinson’s disease and heart disease.
Immobilization of the shoulder may develop after a period of immobilization due to surgery, fracture or other injury, so patients are usually advised to move the shoulder as soon as possible after an injury or surgery can be effective in preventing shoulder arthritis.
Symptoms Adhesive shoulder capsulitis causes pain that is usually dull or achy. It is usually most painful when the shoulder is moved early on. The area of pain is usually located in the outer shoulder area and sometimes in the upper arm.
Before treatment is given, your doctor will determine the type of disease you have by means of a physical examination and imaging.
After discussing your symptoms and medication history, the physician will examine your shoulder, moving it in all directions to check for restriction of movement and pain with movement. The range of motion when someone moves your shoulder is called the “passive range of motion”. Your doctor will compare this “passive range of motion” with your own range of motion of the shoulder (“active range of motion”). People with adhesive capsulitis have a limited range of motion in both passive and active motion.
Imaging tests Some tests that can help your doctor rule out other causes of stiffness and pain include
1 X-rays X-rays can show the structure of the bones very clearly and can also show other problems in the shoulder, such as arthritis.
2, MRI and ultrasound both of which can show a clearer picture of the soft tissues, such as a torn tendon.
3, Although treatment may take up to 3 years, adhesive capsulitis usually gets better over time.
4, Treatment focuses on pain control and restoration of motion and strength through physical therapy.
5.Non-surgical treatment is used to control pain and restore motion in over 90% of patients with relatively simple treatments.
6.Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can reduce pain and swelling.
7. Steroid injections of cortisol, a powerful anti-inflammatory drug, are injected directly into the shoulder joint.
Physical therapy specific exercises will help to restore motion, this may be under the supervision of a physical therapist or as a home exercise program, treatment includes stretching exercises or range of motion exercises for the shoulder. Sometimes a hot compress before stretching exercises can help relax the shoulder. Here are some examples of suggested exercises.
External Rotation – Passive Stretch Stand in a doorway and bend your arm 90 degrees to reach the door frame. Keeping your hands still, rotate your body as shown in the picture, hold for 30 seconds, relax, and then continue repeating the previous movements.
Bend forward – lie on your back with your legs straight, lift your frozen shoulder arm over your head with your normal arm until you feel a slight stretch, hold for 15 seconds, then slowly lower your arm back to the starting position, relax and repeat the previous movement.
Crossed arm extensionGently pull one arm across your chest, slightly below your chin, and extend it as far as you can without feeling pain, hold for 30 seconds, relax, and then continue repeating the previous movements.
Surgery If your symptoms are not relieved by physical therapy and anti-inflammatory medication, then you may want to consider surgery. It is important to talk further with your doctor to understand the feasibility of continuing with simple treatment and the potential risks associated with surgery.
The goal of frozen shoulder surgery is to loosen the stiff joint capsule, and the most common methods include examination and treatment with shoulder arthroscopy under anesthesia. During this procedure, you are placed in a sleep state. Your surgeon will move your shoulder joint vigorously to release and increase the mobility of the joint by tearing away the scar tissue of the joint capsule.
During this procedure, your doctor will make an incision in the tense part of the shoulder capsule and insert a pencil-sized device into the shoulder joint cavity. In most cases, maximum results are obtained with a combination of manipulation and arthroscopy, and many patients have very good results with arthroscopic manipulation treatment.
The arthroscopic view shows the normal joint structure on the left and the intra-articular structure of the patient with frozen shoulder on the right. Restoration of postoperative physical therapy is essential to maintain postoperative joint mobility. The recovery time varies from 6 weeks to 3 months. Although this is a slow process, adherence to treatment is an important factor in returning to daily activities.
Long-term results after surgery are generally favorable, with most patients being able to reduce or eliminate pain and greatly improve mobility angles. In some cases, however, even after several years, mobility does not completely improve and mild tonicity develops. Although rare, recurrent frozen shoulder is particularly common in diabetic patients.