By Health Square desk Adhesive capsulitis, commonly known as frozen shoulder is a inflammatory condition. It is characterized by shoulder stiffness, pain, and significant loss of passive range of motion. It has a prevalence of 2% to 5% in general population.
People with frozen shoulder typically experience:
- Gradually increasing shoulder stiffness
- Severe pain that usually worsens at night
- Near-complete loss of passive and active external rotation of the shoulder.(2)
There are typically no significant findings in the history, clinical examination or radiographic evaluation of patient to explain the loss of motion or pain.
Frozen shoulder generally presents between the ages of 50 years and 60 years.
It rarely and rarely presents before 40 years.
Women (58%) are more likely to develop frozen shoulder than men (42%).
The non-dominant shoulder is more prone to be affected.
The most common comorbidity in people with frozen shoulder is diabetes, both type 1 and type Prevalence of frozen shoulder in people with diabetes is much higher.
Stages of Frozen Shoulder
Frozen shoulder often progresses in four stages:
- Painful Stage
- The freezing (painful)
- Frozen (adhesive)
- Thawing phase
Freezing Stage
The freezing stage lasts about 2–9 months. In this stage, there is an early gradual onset of severe shoulder pain that typically worsens at night.
Frozen Stage
The pain will decrease during the frozen stage with a characteristic increasing loss of 180-degree shoulder movement, arm abduction (moving the arm away from the body), and internal and external rotation. This stage can last for 4–12 months.
Thawing Stage
During the thawing stage, the person experiences a gradual return of range of motion. It may take about 5–26 months to complete.
Although adhesive capsulitis is often self-limiting, it usually resolves in one to three years. However, it can persist, presenting symptoms commonly mild; pain is the most common complaint.
| Stage | Symptoms | Duration of Symptoms |
| I Painful Stage | Moderate pain and reduction of movement | less than 3 months |
| II Freezing Stage | Severe pain and reduction of movement | 2-9 months |
| III Frozen Stage | Pain may be present but stiffness predominates | 10-14 months |
| IV Thawing Stage | Minimal pain and gradual improvement in movement | 14-24 months |
Frozen Shoulder Reasons
The exact cause of a frozen shoulder is not fully understood. However, some risk factors have been identified, including:
- Diabetes mellitus
- Stroke
- Thyroid disorder
- Shoulder injury
- Parkinson disease
- Cancer
- Complex regional pain syndrome
Frozen shoulder can also occur due to the formation of scar-like tissue in the joint capsule, causing it to thicken and shrink. It results in a significant loss of range of motion.
Frozen shoulder can be primary, occurring spontaneously, or secondary. It can develop after an accident or shoulder immobilization.
Frozen shoulder is a self-limiting condition that usually gets better, especially if diagnosed early. Treatment strategies can range from conservative options to surgical intervention, and may include physical therapy.
Treatment
Most treatment options for frozen shoulder are non-operative and include pharmacological management and physical therapy.
In most cases, the recovery occurs within 18 to 30 months. Treatment is aimed on symptomatic relief and improving range of motion (ROM). The following are some viable treatment options:
- Physical therapy or exercising at home can be helpful in managing the issue at early stages.
- NSAIDs are used for pain control.
- Physical therapy: In some cases, gentle ROM exercises such as stretching, and graded resistance training have been shown to reduce pain and increase function.
- Oral corticosteroids can provide short-term pain relief for improved ROM and function. The benefits often last up to a few weeks. Weigh the risks of corticosteroids and benefits when considering this treatment option.
- Shoulder manipulation: The shoulder joint is gently moved while the person is under a general anesthesia.
- Intra-articular steroid injections Injections given in joints) have demonstrated benefits in improving function, reducing pain, and increasing ROM.
- Hydrodilatation: This treatment modality injects the shoulder joint capsule with saline and steroids. This treatment approach has shown short-term benefits in reducing pain and improving ROM and function.
- Shoulder arthroscopy: A minimally invasive type of surgery using a small endoscope, or tube. It is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions.
- Open capsular release is useful for people with strokes or head injuries and those with posttraumatic or postsurgical inflammations of the shoulder joint capsule may be candidates for open release. Open release involves a larger incision to directly access and release the thickened and contracted joint capsule. This procedure has higher morbidity as compared to arthroscopic capsular release.
Summary
People with frozen shoulders typically experience shoulder stiffness and near-complete loss of external shoulder rotation.
Frozen shoulder occurs in three phases: freezing (painful), frozen (adhesive) and thawing. Common treatments for frozen shoulder include NSAIDs, glucocorticoids given orally or as injections in the joint, or other invasive procedures.
Physical therapy and exercises can be a first-line treatment for a frozen shoulder at this early stage of the condition.
Sources:
- Frozen shoulder. (2015, October 23)
https://patient.info/health/frozen-shoulder-leaflet - Frozen shoulder. (n.d.)
https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder - Widmer, B. (2011, January). Frozen shoulder
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025851/ - Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7720362/table/T1