The shoulder is the most mobile joint in the human body, with a complex arrangement of structures working together to provide the necessary movement. The shoulder is a ball-and-socket joint made up of three bones: the humerus (the bone in the upper arm), the scapula (the shoulder blade), and the clavicle (the collarbone). A strong network of soft tissues and bones work cohesively to provide movement and stability to the shoulder. The head of the humerus fits into a shallow socket in the scapula with the shoulder capsule, which is a strong connective tissue, surrounds the shoulder joint. Synovial fluid lubricates the joint and the shoulder capsule to ease the movement of the shoulder.
Frozen shoulder, which is also known as adhesive capsulitis, is a condition that begins with a gradual onset of pain and a limitation of shoulder motion which gradually gets worse, making the shoulder very hard to move. The discomfort and loss of movement can become so severe that even simple daily activities become difficult. In frozen shoulder, the shoulder capsule thickens and becomes very stiff due to the development of stiff bands of tissue, called adhesions. Sometimes, there is less synovial fluid in the joint contributing to the stiffness.
The classic sign of frozen shoulder is limited motion with pain. The condition develops in three states with each stage lasting a variable length of time:
- Stage 1: Freezing Stage - In the freezing stage pain gradually increases with any movement of the shoulder joint. As the pain worsens, the shoulder progressively loses its range of motion. This stage can last anywhere from six weeks to nine months.
- Stage 2: Frozen Stage - In the frozen stage, the pain may diminish, however the shoulder becomes stiffer and any movement becomes extremely difficult. This stage can last anywhere from four to six months.
- Stage 3: Thawing Stage - In the thawing stage, the range of motion in the shoulder slowly starts to improve and the strength in the shoulder has the ability to return to normal or close to normal. This stage can take anywhere from six months to three years.
The diagnosis of frozen shoulder is made only after a careful history and physical examination is performed. The physician will examine the shoulder by moving it in all directions to test the passive range of motion within the shoulder joint and then ask the individual to move the shoulder to compare the active range of motion. Typically, a frozen shoulder can be diagnosed by a physical exam and X-rays, but in some cases, the physician may order an MRI scan to rule out other problems.
Though it may take up to three years, frozen shoulders generally get better over time. The main goal of the treatment is to control pain and restore motion and strength while speeding up the rate of recovery, with the help of physical therapy.
Medication - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling.
Physical Therapy - Physical Therapists will often prescribe specific range of motion exercises that promote healing and help recover as much mobility in the shoulder joint as possible. It is crucial that these exercises be done accurately and routinely to optimize recovery of the mobility of the shoulder joint.
Surgical and Other Procedures - Surgery should only be considered if the symptoms do not improve after prolonged non-operative treatment. The specific procedure will depend on the severity of the condition and should be discussed with the physician extensively:
- Steroid Injections - Injecting the shoulder joint with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain and improving shoulder mobility in the early stages of a frozen shoulder.
- Shoulder Manipulation - This procedure typically requires the individual to undergo anesthesia. While they are asleep, the physician will force the shoulder to move which causes the shoulder scar tissue to stretch or tear. This procedure released the stiffness and increases range of motion.
- Surgery - Shoulder arthroscopy for frozen shoulder is rare, however if more-conservative treatments and other procedures have not helped reduce symptoms, the physician may recommend surgery to relieve adhesions or scar tissues from the shoulder joint.
Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to restore range of motion. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to. Recovery after surgery can take anywhere from four to six months depending on the complexity of the procedure, but the individual's commitment to following all the exercises prescribed by the physical therapist is the most important factor in returning to all the desired activities.
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