Frozen Shoulder Syndrome

Is your shoulder stiff?

Frozen shoulder syndrome, stiff shoulder or adhesive capsulitis are the names for a shoulder disease of unknown cause which is characterized by pain and loss of mobility of the affected shoulder in all directions. The syndrome results in gradual movement limitations in the shoulder joint. There are two basic types of this disorder. In the first, there is no known cause and cannot be associated with any other known disease.

It is more frequently associated with women in the fifth and sixth decade of life. The second type is associated with other conditions such as diabetes, thyroid disorders, lung cancer, tuberculosis, myocardial infarction, post-mastectomy state and shoulder injuries.

During the disease the shoulder joint capsule retracts and becomes thicker, therefore smaller and less elastic. In the beginning, the patients complain of shoulder pain and limited movement. After a few months in the so-called „frozen phase“, patients complain of great pain and significant loss of movement. The so-called „stiff phase“ occurs next, when the shoulder becomes almost totally stiff, but the pain is reduced. This phase lasts for the next few months after which spontaneous recovery happens. In the final phase, the movements in the shoulder regain and pain disappears in the next 6 to 9 months.

Most important step in treatment is timely and correct diagnosis. Treatment usually consists of long-term physical therapy under supervision of a physiotherapist or at home. Before the exercise it is advisable to cool down that shoulder area rubbing ice on it for a few minutes so that all patients could do a bigger number of movements with less pain. For reducing pain, corticosteroids can be applied locally in the shoulder joint as well as using non-steroid antirheumatic drugs.

Local application of corticosteroids in the shoulder joint should be used no more than three times (injections) per year because of the potential harmful effect. In case of very painful and resistant cases, surgery is advised. It is made of manipulating the shoulder in general anesthesia and/or controlled arthroscopic relaxation of the joint capsule in the aim of achieving greater mobility. The treatment is not done with this. Even then long-term physical therapy is needed to regain the shoulder function. Physical therapy is the part without which there is no regaining of shoulder function in this disorder.

All other methods such as pills, injection or surgeries are just auxiliary methods. It is of utmost importance to inform the patient about the disease course. The treatment effects can be achieved only with maximal patients from the physician, patient and physiotherapist. A small number of patients, despite the treatment, unfortunately do not regain the shoulder function fully.

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