FROZEN SHOULDER - A COMPREHENSIVE APPROACH
Adhesive Capsulitis - more commonly known as Frozen Shoulder
What is adhesive capsulitis and what causes it?
Adhesive capsulitis, or frozen shoulder, is an inflammatory condition characterised by stiffness, pain and reduced range of motion in the shoulder joint. The exact mechanism is not fully understood and frequently there is no identifiable cause; however, there are a number of factors which can increase your risk.
What factors increase the risk of adhesive capsulitis?
Age: adhesive capsulitis most commonly occurs between the ages of 40 and 60 years, with incidence increasing with age.
Gender: Women are more commonly affected than men. The reason for this gender difference is not fully understood.
Certain medication conditions: Certain diseases have been associated with an increased risk of developing adhesive capsulitis. These include:
Diabetes
Thyroid Disorders, in particular hypothyroidism
Cardiovascular Disease including hypertension
Stroke
Parkinson's disease
Dupuytren's contracture
Shoulder Trauma or Surgery.
Prolonged Immobilization or Inactivity
Genetic Predisposition. It may run in the family
Repetitive Stress or Overuse
Hormonal Factors: Hormonal changes, such as those occurring during menopause, pregnancy, or hormonal therapy.
How long does it last?
The duration can vary widely among individuals. Typically, the condition progresses through three stages over the course of 1 to 3 years.
Freezing: The initial stage is characterised by increasing shoulder pain, particularly at night, and progressive loss of shoulder mobility. This stage typically lasts between 2 to 9 months.
Frozen: During this stage shoulder pain can but does not always moderate, while stiffness and reduced range of motion persists. This stage can last from 4 to 12 months.
Thawing: In the final stage, shoulder mobility gradually improves and pain diminishes. Full recovery can take several months to years, with some individuals experiencing ongoing stiffness and limited range of motion.
It's important to note that individual experiences with frozen shoulder can vary greatly and some people may recover more quickly or slowly than others.
What are your treatment options?
Evidence suggests early intervention can help shorten the duration of symptoms and improve outcomes. Treatment should aim to alleviate pain, improve shoulder mobility, and restore function.
Physiotherapy is the cornerstone of Adhesive Capsulitis management. Exercise, stretching techniques and manual therapy are employed to improve shoulder mobility and reduce pain. Physiotherapy should include education and a home exercise program.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, may be prescribed to help alleviate pain and reduce inflammation.
Hydrodilatation involves injecting cortisone and a sterile solution (usually saline) into the shoulder joint. The cortisone has anti-inflammatory and pain-relieving effects while the saline stretches the capsule and helps break up adhesions. This procedure is performed by a medical professional under imaging guidance. Click HERE to read Dr Krishant Naidu blog on Adhesive Capsulitis.
Manipulation Under Anesthesia (MUA): In cases where more conservative treatments have failed to improve shoulder mobility, manipulation under anesthesia (MUA) may be considered. During MUA, the patient is placed under anesthesia, and a doctor manipulates the shoulder to break up adhesions and improve range of motion.
Surgical Intervention: In rare cases where other treatments have been ineffective, surgical intervention may be necessary to release the tight capsule and restore shoulder mobility.
It's important to note that the treatment selection depends on individual patient factors, including the severity of symptoms, patient health and comorbidities, and patient goals. A comprehensive approach involving collaboration between the patient, doctor and physiotherapist is recommended for the best outcome.