Understanding Frozen Shoulders - Symptoms, Causes and Treatment


The shoulder joint has a unique joint structure which is designed to enable extensive three-dimensional mobility and quick reflexive responses. However, this amount of flexibility comes at the cost of its stability and durability.

Stiff shoulders are one of the adverse sequelae caused due to fractures or dislocations of the shoulder, cervical or thoracic surgery, or immobilisation for treating any upper limb surgery.

Often known as ‘adhesive capsulitis’, the evolution of the frozen shoulder condition can be summarised in four stages: However, It is traditionally regarded as a self-limiting condition, which universally settles and recovers with or without treatment over a variable time course.

Stage 1: After the symptoms have been present for three months, there is a mild loss of front flexion, abduction and internal and external rotation, and an aching pain which aggravates while moving the arm.

Stage 2: Also known as the ‘freezing stage,’ which occurs after the symptoms have been present for 3 to 9 months, and there is a significant and persistent loss of all movements.

Stage 3: With the symptoms continuing for 9 to 14 months, this ‘frozen stage’ occurs after the previous painful phase, which has now substantially settled but leaving a relatively painless but stiffened glenohumeral joint.

Stage 4: Some amount of gradual improvement occurs in this ‘thawing stage’, between the 15th and 24th month. The pain is reduced due to capsular remodelling, which also causes a progressive increase in the range of movement.


Causes Of Frozen Shoulder:

There are three primary causes which lead to a stiff shoulder:

Injury And Inactivity:

Stiff shoulders may be caused due to various intrinsic and extrinsic disorders, such as:
  • Rotator cuff tears
  • Biceps tendonitis
  • Upper limb fractures
  • Cervical spine disorders
  • Intrathoracic pathology
  • Abdominal pathology

Systemic disorders:


  • Stroke
  • Heart condition
  • Thyroid disorders (hypothyroidism)
  • Parkinson’s disease
  • Diabetes Mellitus
  • Cardiovascular disease
  • Tuberculosis
  • Cytokine secretion

Age and Gender:

  • Frozen shoulders happen to occur more commonly in females than males.
  • Also, the chances of this condition increase rapidly after the age of 40

Symptoms of Frozen Shoulder:

Although hard to detect initially, this condition can be diagnosed by a few standard symptoms, which include:
  • Feeling stiffness in the shoulder when at rest
  • Reduced range of joint motion in all directions
  • Gradually growing pain and inflammation in and around the joint

Treating Frozen Shoulder:

All frozen shoulder treatments are aimed at reducing the time taken for recovery by relieving pain and improving the range of motion. The first priority is to reduce pain as, without proper pain relief, rehabilitation will be inadequate and intolerable.

Medications:
  • You can opt for over-the-counter non-steroidal anti-inflammatory medications that have no contra-indications.
  • Opiate based painkillers must be avoided as they can get quite addictive.
  • You may opt for steroid injections which are directly injected into the joint to relieve pain and improve mobility. Intra-articular steroid injections are more effective if administered in the early stages of the problem.
  • Joint distension is another technique where sterile water is injected into the joint to relax the connective tissues and improve range of motion.

Exercises:

  • The objective of physical therapy is to restore shoulder functionalities by reducing inflammation and pain via stretching exercises and reestablishing normal shoulder mechanisms.
  • A good physiotherapist can guide you through several stretching exercises which help restore range of motion for frontal elevation, external rotation, internal rotation and cross-body adduction.
  • Distension arthrography is another process where fluids are insufflated into the glenohumeral joint for either stretching or rupturing of the joint capsule.

Shoulder Manipulation Technique:

  • Shoulder manipulation under general anaesthesia (MUA) is a non-surgical procedure where your shoulder joint is stretched in all directions to loosen it up.
  • Provided the clinician is aware of the contraindications to the use of MUA technique, it can be an effective therapy for frozen shoulders that aren’t responding to physiotherapy.

Release Surgery:

  • The objective of open release surgery is to remove the adhesions in the shoulder joint and free up both intra-articular and extra-articular structures.
  • It is especially useful in treating patients when manipulation might lead to disruption.
  • This ARTHROSCOPIC surgery is performed . through keyholes. It is a one day (day care) procedure

If you’re having such shoulder trouble for a long time and are in need of the best shoulder specialist in Mumbai, then you must pay a visit to Dr Pranjal Kodkani, one of the very few joint preservation and sports injury specialists today. With exhaustive experience in treating athletes for joint injuries both surgically and non-surgically, he is widely known to provide highly effective options for shoulder treatment in Mumbai. Visit Dr Kodkani’s website to learn more about his therapeutic and consulting services.

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