Frozen Shoulder – Adhesive Capsulitis Shoulder – Signs, Symptoms, Diagnosis, Treatment

Frozen Shoulder or Adhesive Capsulitis of Shoulder as is technically called, is an inflammatory disorder of the shoulder joint capsule. It produces global restriction of shoulder movements. Most patients in their 30’s to 50’s age often present as progressive pain and stiffness of the shoulder joint, which starts as a painful shoulder and later produces stiffness. Usually the symptoms range from weeks to months. Usually, patients do not remember any precipitating event before the start of symptoms.

Diabetics are the worst hit. Although, it may occur in any individual, patients with Uncontrolled Diabetes Mellitus tend to suffer more often. The important point of differentiation is between Frozen shoulder and other more serious pathologies involving the shoulder joint. The common differentials include- Rotator Cuff Tear, Impingement syndrome and Septic Arthritis.

Rotator cuff tear usually happens in the young active individual; although degenerative tears in elderly are also described. It produces weakness of movements in the plane of action of the affected muscle group. Impingement syndrome produces pain on sideways elevation of the upper limb; it may happen due to inflammation of the rotator cuff tendons or abnormal bony overgrowth limiting the free excursion of the tendons around the shoulder joint. Septic Arthritis has a fulminant course associated with systemic signs – like fever, swelling and redness of shoulder joint.

Frozen shoulder is a self limiting disorder; unless associated with another pathology. It has three distinct phases, characterized by pain, stiffness and then resolution of symptoms. The typical duration of phases is 3-6 months. Because Frozen shoulder or Adhesive capsulitis is a self limiting disease, the treatment is directed at supportive care.

Most patients respond well to a short course of anti-inflammatory medication in the painful phase. This is the phase which is most troublesome. In the stiffness phase, aggressive physiotherapy may be started to improve shoulder range of movements. In some patients who do not respond to physiotherapy, manipulation of shoulder under anesthesia may be preformed. This is done after injecting the shoulder with local anesthetic solution and physiological saline. Shoulder arthroscopy is another options for patients suffering with recurrent adhesions and shoulder stiffness.


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