What is frozen shoulder?
Frozen shoulder or adhesive capsulitis is a painful condition in
which the shoulder loses its range of movements. This condition is
referred to as "frozen shoulder" because it becomes very difficult
for a person to move his shoulder. The shoulder is not actually
frozen, it is just stiff. It may follow an injury to the shoulder,
but may also arise gradually without warning or injury.
What are the causes?
Adhesive capsulitis causes scar tissue to form in the shoulder
region. This may occur as a result of injury. Other conditions
like tendonitis (inflammation or irritation of a tendon) and
bursitis (inflammation or irritation of a bursa). If the shoulder
has been immobilized for a long period of time, adhesive
capsulitis could develop as a result. The condition could also
develop as a result of an autoimmune reaction. The body thinks it
is under attack during an autoimmune reaction and will start to
attack parts of itself causing an inflammatory reaction in the
tissues. However, in most cases, the cause is unknown.
Who is at risk?
* The usual age of onset begins between ages 40 and 65.
* It affects approximately 10% to 20% of diabetics.
* Other factors include: - a period of immobility, resulting from
trauma, overuse injuries or surgery, hyperthyroidism,
cardiovascular disease, clinical depression and Parkinson’s
disease.
What are the symptoms?
Initially, the shoulder may feel stiff and ache and gradually
becomes very painful. This stage can last up to eight months. The
second stage is referred to as the adhesive stage and this is when
the shoulder becomes stiffer. This stage usually lasts 4 to 6
months and is generally less painful than the first stage. The
final stage lasts about one to three months. At this time, it
usually becomes easier to move the shoulder. Pain may still
persist and the full range of motion may still not be got with
treatment.
It hurts the patient regardless of whether he moves the shoulder
or someone else is moving it for him. The movement will simply
stop if there was something preventing the shoulder from moving
any further. The pain may increase at night.
How is the diagnosis made?
A doctor will examine the patient and ask for his medical history
to be able to accurately diagnosis his condition. Other conditions
have similar symptoms to adhesive capsulitis so the doctor may
need to take an X-ray.
The most common test used is the MRI scan. An MRI scan is used to
create pictures that look like slices of the shoulder. This scan
is used to create pictures that look like slices of the shoulder.
It can show the tendons as well as the bones, and whether there
has been a tear in those tendons.
What is the treatment?
Successful treatment of adhesive capsulitis include:
* Anti-inflammatory drugs
* Cortisone injections to the shoulder
* Physical therapy
Anti-inflammatory drugs and cortisone injections reduce the
inflammation of the shoulder allowing the shoulder to be more
easily stretched. Physical therapy is essential because it helps
regain the range of motion in the shoulder.
Treatment can be a long process. Initial treatment is aimed at
reducing inflammation and pain and increasing the range of motion
of the shoulder. Exercise is a very important part of the
treatment. Exercises will help break up the scar tissue in the
shoulder and should be done twice a day. The doctor or physical
therapist will show the patient what kind of exercises should be
performed. Since the exercises may be painful, using ice packs
afterwards may help. With all exercises, the patient should warm
up before attempting to do them.
If progress is slow, the doctor may recommend a manipulation of
the shoulder while the patient is under anaesthesia. This
procedure allows the doctor to stretch the shoulder joint capsule,
and break up the scar tissue. In most cases, a manipulation of the
shoulder will increase the motion in the shoulder joint faster
than allowing nature to take its course. It may be necessary to
repeat this procedure several times.
Arthroscopic surgery may also help break up the scar tissue. A
camera is inserted through a small incision allowing the doctor to
access the damage to the joint and at the same time, aid in the
healing process.
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