Frozen shoulder or Adhesive capsulitis is an extremely painful and debilitating condition in which movement of the shoulder is severely restricted and even small routine tasks become impossible. In it the capsule surrounding the shoulder joint contracts and forms scar tissues. Pain is constant and certain movements can cause sudden onset of excruciating pain and cramping that can last several minutes. In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems in sleeping as pain becomes worse at night, resulting in chronic fatigue, depression, pain in the neck and back, as well as damage to the surrounding tissues.
Frozen shoulder affects about two percent of the general population. It affects most commonly patients between the ages of 40 and 60 years, is more common in women and mostly affects the non-dominant shoulder.
This condition, for which an exact cause is unknown, can last from five months to 3 or 4 years or more and is thought in some cases to be caused by injury or trauma to the area. Frozen shoulder occurs more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk.
The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint. Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become extremely painful.
Physicians have described the normal course of a frozen shoulder as having three stages:
Stage one: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.
Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts four months to nine months.
Stage three: The "thawing" or recovery, when shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.But full range of movement may not be regained.
Treatment may be painful and taxing and consists of medication, physical therapy and massage therapy. Physical therapy is very important at all stages of Adhesive Capsulitis, despite aggravating some amount of inflammation and pain, as it will prevent further loss of range and painful contracture. Diligent physical therapy is often the key and can include ultrasound electric stimulation, range-of-motion exercise maneuvers, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder. Pain and inflammation can be controlled with analgesics and non-steroidal anti-inflammatory drugs.
Sometimes frozen shoulders are resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.
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