Adhesive Capsulitis: Frozen Shoulder

Adhesive capsulitis or frozen shoulder as it is more commonly known, is a painful condition of the shoulder where the range of motion is significantly depleted. It is generally a chronic condition which progressively becomes worse over a period of time, but then slowly begins to resolve. This process can take 1-3 years without any treatment input, however there are options when it comes to treatment. This article will discuss the causes, symptoms and treatment options for a frozen shoulder.

The glenohumeral joint, which is the main joint in the shoulder girdle, is affected by frozen shoulder. The structure of the glenohumeral joint makes it very mobile – capable of the largest range of movement out of any joint in the human body. However, this mobility comes at a cost – it is also the most unstable joint in the body, and as a result is prone to injuries and other dysfunctions.

The cause of frozen shoulder is a thickening and inflammation of the joint capsule of the shoulder, which is made up of the ligaments, tendons, bones and other connective tissue that make up the joint. This thickening of the capsule reduces the space in the joint, which causes reduced movement because the joint can no longer move freely and fluidly. In a normal shoulder capsule there are sections that can expand and shrink to allow for movement of the shoulder, and these end up with scar tissue and adhesions developing.

The condition progresses in three stages, called freezing, frozen and thawing.

Freezing

During the freezing stage the condition gets progressively worse, with significant increases in pain and reduced range of motion as a result of the restriction in the joint capsule. This stage can last for anything from a number of weeks up to a year. Generally it lasts for several months, during which time pretty much all movement is painful and some movements are more or less impossible.

Frozen

During the frozen stage the symptoms plateau and stop getting worse, but they continue to persist at the same painful levels. Again, this stage can last for several months with no improvements and it can feel like it’s never going to end.

Thawing

The final stage of a frozen shoulder is essentially the recovery stage. The symptoms slowly begin to dissipate, and in most cases full range of motion returns to the joint. This can take up to 2 years, but usually happens over a series of months. Depending on the severity and circumstances under which the frozen shoulder began, the full range of motion does not always return to the joint, however with good management it is usually possible.

Risk Factors

There are a number of risk factors involved with frozen shoulder. Some individuals are much more likely to develop a frozen shoulder, such as women who are over the age of 40. Other risk factors include those who have limited mobility in their shoulder; those who have had illnesses such as strokes, and those who have had rotator cuff injuries or fractures.

Individuals with diabetes are at a much greater risk of developing frozen shoulder. Diabetics, especially those with high blood sugar levels that persist, or those who have uncontrolled diabetes, are most at risk. Collagen is a protein that forms connective tissues throughout the body, including the joints. Sugar attaches to this collagen, which prevents the collagen from fully functioning, which leads to restriction in the joint. In extreme cases this can lead to almost total loss of movement.

Treatment

Frozen shoulder will follow a course of progression; initially getting worse (freezing) and then getting better (thawing), regardless of any intervention. There are both exercise/therapy based treatments as well as surgical options, however surgical options generally have less success than an exercise based approach (Nagy et al 2013). Further to this, the most successful outcomes tend to come from those who complete gentle exercise based rehab, rather than intense treatments (Griggs & Green 2000).

Massage therapies and acupuncture are also beneficial forms of treatment, provided they are not too aggressive; and the tend to compliment an exercise programme. Anti-inflammatory medication or steroid injections are sometimes considered as a part of the treatment process as well.

References

“The link between diabetes and frozen shoulder” Maryland Orthopaedic Specialists. Retrieved from: https://www.mdorthospecialists.com/blog/the-link-between-diabetes-and-frozen-shoulder#:~:text=People%20with%20diabetes%20are%20at,with%20diabetes%20or%20other%20factors. [Accessed 31/5/2022]

MT Nagy et al (2013) “The frozen shoulder: myths and realities” The Open Orthopaedics Journal. Retrieved from: https://openorthopaedicsjournal.com/VOLUME/7/PAGE/352/ [Accessed 3/4/2022]

“Frozen Shoulder” John Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder [Accessed 4/5/2022]

D Challoumas (2020) “Comparison of treatments for frozen shoulder. A systematic review and meta analysis” JAMA Network. Retrieved from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774247 [Accessed 10/5/2022]

HS Uppal (2015) “Frozen shoulder: A systematic review of therapeutic options” World Journal of Orthopaedics. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/ [Accessed 15/5/2022]

“How to release a frozen shoulder” (2021) Retrieved from: https://www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder [Accessed 15/3/2022]

Griggs & Green (2000) “Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment” The journal of bone and joint surgery. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/11057467/ [Accessed 10/3/2022]

Image Source: https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

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