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Overview
Frozen shoulder is a painful shoulder condition. In this condition there is a marked decrease in both the active and passive movements of the shoulder. As a painful disorder, frozen shoulder lasts longer than three months.
Frozen shoulder is generally defined as a fibrotic, inflammatory contracture of the rotator interval, the capsule and the ligaments.
Causes
The bones, ligaments and tendons that make up your shoulder joint are enclosed within a connective-tissue capsule. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.
Although the reason it develops is unclear, this condition is associated with disorders such as diabetes mellitus, thyroid disease, adrenal disorders and cardiopulmonary diseases. People who have one of these conditions along with frozen shoulder fall into the primary frozen shoulder category.
Secondary frozen shoulder, on the other hand, is frozen shoulder that develops after traumatic accidents (fracture, dislocation, soft-tissue injury, etc.) or together with shoulder problems such as osteoarthritis, rotator cuff tendinopathy or tendinitis. Frozen shoulder, which is seen mostly between the ages of 40 and 65, is more likely to occur in women than in men.
This is a benign condition, meaning it can resolve on its own; however, in one study, an average of seven years after the onset of the disease, 50% of patients still experienced shoulder pain or stiffness, although only 11% reported functional limitation.
This long-lasting pain and disability deprives patients of their routine lives (difficulties with personal hygiene, dressing and brushing their hair) and of their occupational and recreational activities. Another common condition seen together with frozen shoulder is neck pain, mostly resulting from overuse of the cervical muscles to compensate for the loss of shoulder movement.
In order for patients to return to their own lives quickly, an appropriate, individualized treatment must be determined and applied.
Frozen shoulder can be examined in three stages.
The first stage (painful phase) is the stage in which pain is severe and restriction of shoulder movement begins gradually, lasting approximately 0-3 months.
In the second stage (adhesive phase), pain decreases, but the restriction of joint movement gradually increases, and it lasts 3-9 months;
In the third stage (resolution phase), pain decreases and joint movements begin to improve slowly and gradually, lasting 9-15 months.
Patients in the first stage usually present to the clinic with sudden-onset, one-sided anterior shoulder pain. Typical symptoms include restriction of passive and active movement affecting first external rotation and then abduction of the shoulder.
Diagnosis
To diagnose frozen shoulder, two physical examinations are commonly used, including combined movement tests such as touching the shoulder blade from behind the neck and from behind the back.
Diagnosis is made through medical history, physical examination and imaging modalities.
Treatment
The aim of treatment should focus on providing pain control, reducing inflammation and patient education. Initial treatment options for adhesive capsulitis may include acetaminophen or NSAIDs. Physical therapy is important for pain control and for regaining normal shoulder mobility. In physical therapy, manual therapy based on soft-tissue mobilization and gentle stretching is applied. Beyond these, treatment should focus on therapeutic exercise. In addition, electrotherapy applications such as ultrasound, cryotherapy or TENS may also be used. In advanced frozen shoulder, if physical therapy is not effective, more aggressive treatments such as manipulation under anesthesia and arthroscopic capsular release may be performed.