What is Frozen Shoulder and its features

Introduction

Frozen shoulder is also called as periarthritis or Adhesive capsulitis .

it is a clinical syndrome characterized by painful restriction of both active and passive movement of the shoulder due to its cause

Paradoxically shoulder joint is privileged as the most mobile joint in the body has its nemesis because of its advantages

Its mobility makes it very vulnerable to problems, which ultimately “freezes” its movements.

Causes of Frozen shoulder

The exact cause of frozen shoulder can be unknown or it could be idiopathic

The problems directly related to shoulder joint which can give rise to frozen shoulder are:

  • tendonitis of rotator cuff
  • bicipital tendinitis
  • fractures
  • dislocations around the shoulder etc

Problems not related to shoulder joint like are:

  • Diabetes
  • Cardiovascular disease with referred pain to the shoulder
  • Reflex sympathetic dystrophy
  • Frozen hand shoulder syndrome
  • A complication of colles fracture can also lead to frozen shoulder
  • prolonged immobilization of shoulder joint due to referred pain

Pathology

During abduction, and repeated overhead activities of shoulder, long head of biceps and rotator cuff undergo repeated strain.

This results in inflammation, fibrosis and consequent thickening of shoulder capsule, which results in loss of movements

If continued, movements gradually break the fibrosis, and although movements return, they never fully return to normal.

Prolonged activity causes small scapular and biceps muscles to waste faster, load on joint increases and degenerative changes sets in

Fibrosis affects the capsule, causing decreased shoulder movements.

Features

A patient with frozen shoulder clinically presents as follows :

  • Decreased range of both active and passive shoulder movements.
  • The patient demonstrates a capsular pattern of movement restriction that is – external rotation > abduction > internal rotation .
  • At the end stage of stretch, one notes pain.
  • Reduced accessory joint play.
  • Resistive tests are generally pain free in the available range of motion
  • Patient is unable to do routine daily activities like combing the hair, in case women wearing the button or zip on the back
  • He or she cannot do any kind of overhead activities

Clinical Stages

STAGE 1 :

In this stage of pain, the patient experiences acute pain, decreased movements, followed by external rotation, loss of abduction, and then forward flexion

Internal rotation is least affected in this stage, it lasts for 10-36 weeks.

STAGE 2 :

it is the stage of stiffness, in this stage pain gradually decreases and the patient complains of stiff shoulder.

slight movements are present. this last for 4-12 months.

STAGE 3 :

In the recovery stage, the patient experiences no pain, and movements have recovered but never reach normal levels again.

it lasts for 6 months to 2 years

Diagnosis

x – ray of the shoulder is usually normal but in few cases, sclerosis may be seen on the outer edge of greater tuberosity this is also known as Golding’s sign

Stiffness occurs in a variety of conditions arthritic, rheumatic, post-traumatic and postoperative.

The diagnosis of frozen shoulder is clinical, resting on two characteristic features:

(1) painful restriction of movement in the presence of normal x rays

(2) a natural progression through three successive phases.

Treatment

CONSERVATIVE TREATMENT

In conservative treatment, the goal is to relieve pain and prevent further stiffening while awaiting recovery.

It is important not only to administer analgesics and anti inflammatory drugs but also to reassure the patient that recovery is certain.

Manipulation under general anaesthesia may improve the range of movement.

Gently but firmly move the shoulder into external rotation, then abduction, and flexion.

In elderly, osteoporotic patients, special care is needed due to the risk of fracturing the neck of the humerus.

At the end, the clinician injects methylprednisolone and lignocaine into the joint.

An alternative method of treatment is to distend the joint by injecting a large volume (50–200 mL) of sterile saline under pressure

Suggestions for active and passive exercises depend on the severity.

Physiotherapy like ultrasound, heat and shoulder wheel exercise may also help

SURGICAL TREATMENT

The main indication is a prolonged and disabling restriction of movement that conservative treatment fails to address.

ARTHROSCOPIC DISTENSION OR BRUISEMENT TECHNIQUE : this helps to increase range of motion after several weeks or months

ARTHROSCOPIC RELEASES : This indicates recalcitrant cases where all the above measures have failed

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