FROZEN SHOULDER

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. The shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue is also called adhesions. Over time, the ROM (Range of motion) of the shoulder becomes very hard to move. Either the patient or with help of someone else it is not possible to move the shoulder. Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. At the beginning the symptoms are worse. After a period the symptoms get better but it may take up to 3 years.

Anatomy
The shoulder is a ball-and-socket joint made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The joint is surrounded with capsule.

Frozen Shoulder develops in three stages

Stage 1:Freezing In the freezing stage, the pain gets worsens and the patient loses range of motion (stiffness). Freezing stage generally lasts from 6 weeks to 9 months.
Stage 2: Frozen In the frozen stage pain is more less but the stiffness remains. Frozen stage generally lasts from 4 to 6 months. At this stage daily activities may be hard to do.
​Stage 3: Thawing In the thawing stage shoulder motion slowly improves. Thawing stage typically takes from 6 months to 2 years to return to normal or close to normal strength and motion.

Causes

The causes of frozen shoulder is not clear. But diabetes, hypothyroidism, hyperthyroidism, Parkinson's disease, cardiac disease and immobilization may cause frozen shoulder.

Doctor Examination

The orthopedics surgeon does the phyisical examination of the patient, moves the shoulder gently in every direction and also compare with the other shoulder. The doctor gets patient’s medical history and needs some imagings (X-Ray, MRI) and laboratory tests to decide about the treatment and plan about the operation. They are not required to diagnose frozen shoulder, but to identify other problems in the shoulder, such as a torn rotator cuff.

Treatment

Frozen shoulder generally gets better over time, although it may take up to 3 years. The goal of treatment is to control pain and restore motion and strength with nonsurgical or surgical treatment.

Nonsurgical Treatment
Non-steroidal anti-inflammatory medicines (NSAI), Steroid injections (cortizone) and physical therapy (Therapy includes stretching or range of motion exercises for the shoulder)

Surgical Treatment
If the symptoms are not relieved by therapy and other conservative methods, the patient should think about the surgery. The surgery is typically offered during frozen stage. The goal of surgery is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy. Shoulder arthroscopy is the procedure that the doctor puts a camera inside the joint and cuts through tight portions of the joint capsule. In many cases, manipulation and arthroscopy are used together to obtain maximum results.

Recovery

After surgery, physical therapy is necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to 3 months. Long-term outcomes after surgery are generally good. Most patients having reduced or no pain and improved range of motion. Some of the cases the motion may not return completely and some degree of stiffness may remain.