Frozen Shoulder
Frozen shoulder and adhesive capsulitis refer to the same condition. It begins with severe pain and then restriction of motion in the shoulder. The condition is more common in people with diabetes, thyroid disease and in woman over 40 years old. It has also occurred in people recovering from surgery such as heart surgery, or mastectomy. The exact cause cannot always be found but the disease process usually resolves, in some cases taking up to 2 years to regain the range of motion in the shoulder.
Causes
The cause of a frozen shoulder is not completely understood. One theory is that it may be caused by an autoimmune reaction. The body’s defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body. This causes an intense inflammatory reaction in the tissue that is under attack.
No one knows why this occurs so suddenly. For some reason, repetitive motion, trauma or immobilizing a joint in some people seems to trigger the autoimmune response
Other shoulder problems like bursitis, rotator cuff tears, or impingement syndrome can end up causing a frozen shoulder. Physicians theorize that the underlying condition may cause chronic inflammation and pain that make the individual use that shoulder less. This sets up a situation that can create frozen shoulder. Usually, the frozen shoulder must be treated first to regain its ability to move before the underlying problem can be addressed.
Symptoms
- Severe Pain with all motions of shoulder
- Aching pain at night and difficulty sleeping due to pain
- Unable to lift arm even with the help of other arm
- Severe stiffness in shoulder
- Pain at entire shoulder increased with reaching
- Sometimes pain radiating down arm or bicep region
- Unable to reach behind back or hook bra
Treatment
X-rays should be taken to rule out arthritis as cause for stiffness. An MRI may be order if history of trauma to rule out a rotator cuff tendon tear or early arthritis. An MRI or X-rays will not show a frozen shoulder, they will only rule out other causes.
Treatment of this disorder focuses on restoring joint movement and reducing shoulder pain. Usually, treatment begins with nonsteroidal anti-inflammatory drugs and the application of heat, followed by gentle stretching exercises. These stretching exercises, which may be performed in the home with the help of a therapist, are the treatment of choice. The stretches should be done several times a day, everyday, to keep the shoulder from tightening up. In some cases, transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses. If these measures are unsuccessful, the physician may recommend a cortisone injection in the joint to decrease the inflammation of the capsule of the shoulder. If conservative treatment fails, an arthroscopy with manipulation of the shoulder under general anesthesia may be recommended. People with diabetes may have recurrence of a frozen shoulder even with a manipulation. Keeping sugars under control and starting therapy the day after the manipulation will decrease the chance of the recurrence.