Frozen shoulder, also known as adhesive capsulitis, is a condition in which shoulder movements are restricted. Depending on the thickening and tightening of the soft tissues in the shoulder joint, the degree of movement of the arm decreases. Pain, swelling, stiffness complaints occur in the shoulder. Frozen shoulder is more common in people between the ages of 40 and 60. It occurs slightly more often in women. It is a condition that is seen in 2-5% of the society, so it cannot be said that it is very rare.
Frozen shoulder is most often confused with fiber tear in the shoulder. There is also pain and limitation of movement in shoulder fiber tears. The reason for the limitation of movement is fiber damage or tears. In frozen shoulder – adhesive capsulitis, the reason for the limitation of movement is the inflammation of the shoulder joint capsule (capsulitis) and adhesions between the connective tissues. The shoulder capsule is a connective tissue that surrounds the joint, it keeps the bones in place and prevents dislocations. In frozen shoulder, this capsule thickens and contracts and limits joint movements.
What Are the Symptoms of a Frozen Shoulder?
Frozen shoulder disease is divided into 3 stages. In the first stages (first stage), there is shoulder pain. Before long, arm movements are restricted due to pain. The less the shoulder is moved, the greater the stiffness. After a while, even if you force it, you will not be able to raise your arm above your head and lie on your back. Movements that require the arm to reach and rotate, such as reaching for a high shelf, putting on a shirt, fastening the seat belt, wearing a bra, become more difficult. It is not possible to lie on that side over the shoulder due to pain. The first stage can last from 3 to 9 months. When the initial inflammation subsides, the pain subsides, but the stiffness persists. This is the freezing phase (second phase). The second phase lasts an average of 9-15 months. Finally, in the third stage, the movements gradually return to normal, but it may take up to a year for this to happen.
Who Gets Frozen Shoulder?
Diabetes, hormonal imbalances (hyperthyroidism, hypothyroidism), chronic systemic diseases that cause weakening of the immune system create a predisposition to frozen shoulder – adhesive capsulitis. Diabetes increases the risk of this problem 3 times. Although these diseases increase the risk of frozen shoulder, it is not known exactly why it occurs in some people and not in others. Staying immobile as a result of any disease (stroke, etc.), surgery or trauma causes adhesions between the connective tissues of the shoulder and adhesive capsulitis may occur. Adhesive capsulitis may take 3 to 9 months to set.
Which Department to Go to for Pain and Stiffness in the Shoulder?
A physical therapy and rehabilitation doctor is consulted for acute non-traumatic shoulder pain, including frozen shoulder. First, questions are asked about the onset of the complaints, the nature of the pain, and other accompanying symptoms. Then the examination is done. Shoulder range of motion, pain and tenderness, and muscle strength are examined. With some special examination methods, it can be understood which anatomical structures are affected in the shoulder. Problems such as joint calcification can be seen on X-ray. Problems in the shoulder muscles and fibers are best seen on MRI (shoulder joint MRI).
Frozen Shoulder Treatment
Frozen shoulder can continue for 1 to 3 years if left untreated; may eventually correct itself. The healing process can be accelerated with physical therapy. The aim of physical therapy is to reduce pain, stretch the shoulder joint and relieve the limitation of movement. In the first stage, the goal of reducing pain is in the foreground, aggressive stretching is not recommended while the inflammatory process continues. After the inflammation subsides, the focus is on restoring movement and functions. With exercise and joint mobilization, positive results can be obtained after a few weeks or months. Electrotherapy, superficial and deep warming physical therapy methods are useful in reducing pain and increasing the flexibility of the connective tissue.
Some pain medications can be used for short periods of time to reduce pain. Injections containing corticosteroids and local anesthetics can be made to reduce inflammation in the shoulder and open up adhesions.
Physical therapy for frozen shoulder usually takes several weeks. However, cold or hot applications and exercises should be continued at home. Most patients recover this way without the need for surgery.
Surgery for frozen shoulder can be done open or closed. The aim is to open and loosen the adhered tissues. Under anesthesia, the shoulder is restored to full range of motion. Good physical therapy is also essential for a permanent post-operative recovery; Otherwise, it may jam again.