Frozen shoulder, also called Adhesive Capsulitis is a condition characterised by pain and loss of motion in shoulder joint. It is more common in older adults aged between 40 and 60 years and is more common in women than men.
Causes
Frozen shoulder is caused by inflammation of the ligaments holding the shoulder bones to each other and of the bag supporting the ball and socket joint (capsule). The shoulder capsule becomes thick, tight, and the stiff bands of tissue called adhesions may develop. The cause maybe unknown (Primary) or due to known cause (Secondary) either within the shoulder (Intrinsic) such as inflammation, tear, calcification of the tendons or infection or outside the shoulder (Extrinsic) such as due to neck, breast or heart problems or due to generalized problem affecting the body (Systemic) such as diabetes, hypothyroidism, Parkinson’s disease, stroke or rheumatological arthrites. Individuals with shoulder injury, shoulder surgeries, and shoulders immobilised for longer periods are also at risk of developing frozen shoulder (Tertiary).
Symptoms
Frozen shoulder may cause vague onset of pain, progressive disabling stiffness and limit the movements of shoulder. Often the presentation may mimic a neck problem in the early stages.
Diagnosis
Frozen shoulder is usually diagnosed clinically with restriction of passive shoulder movement in all planes compared to the opposite shoulder. Dr Bala may also examine the neck, heart, breast or the rest of the body to identify any underlying causes. Sometimes examination findings may be misleading in early stages and Dr Bala may reassess you at a subsequent visit. Diagnostic procedures are aimed to identify an underlying local or systemic cause. Dr Bala may order x-rays, a shoulder ultrasound, blood tests. MRI scans may be misleading in the early stages of the disease but may show a contracted capsule in the later stages.
Conservative Treatment
The aim of conservative treatment is to limit the pain and improve movement by physiotherapy
Conservative Treatment options include:
- Analgesia such as Panadol or Non-steroidal anti-inflammatory drugs
- Oral steroids are usually not effective
- Steroid injections in and around the shoulder for pain which are safe if directed accurately. Dr Bala may wait until your diabetes is well controlled before offering a steroid injection.
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- Physiotherapy to improve your range of motion once pain is controlled.
- Sometimes local ultrasound or heat may be applied to reduce pain.
Treatment is also addressed at the underlying cause either locally or systemically. For eg stricter diabetic or thyroid control. Underlying intrinsic causes such as tendon tears, inflammation or calcification are also usually not addressed until the shoulder function and movement has improved. Once the pain resolves, there is a gradual onset of stiffness which may also improve over many months.
Surgery
If conservative treatment over 9 months has failed to improve shoulder movements to a point where it has become disabling, then intervention may be recommended.
Dr Bala does not believe in manipulation under anaesthesia or distending the shoulder capsule as an isolated procedure especially if youre diabetic or have had a tendon repair previously in your shoulder.
Shoulder arthroscopy with manipulation may be indicated if the shoulder stiffness has become disabling beyond 6 to 9 months. During surgery, the scar tissue will be removed circumferentially and tight ligaments, if any, will be dissected and released (arthroscopic capsular release/ 360 deg release/ CHL ligament release).
Dr Bala usually also cuts the biceps tendon within the shoulder (biceps tenotomy) and may reattach it outside the shoulder (tenodesis) along with the 360 release, as this is often a cause of pain. Following surgery, physiotherapy will be advised to bring full range of motion and strengthen the muscles.