Frozen shoulder or adhesive capsulitis, is a common disorder of the shoulder. It is characterised by moderate to severe pain around the shoulder and reduced range of movement and stiffness. The condition may be provoked by injury or trauma and maybe predisposed to by poor posture increasing the pressure on the shoulder. Often the condition can arise spontaneously but diabetics, and sufferers of stroke, rheumatoid arthritis, lung and heart disease are at greater risk. It generally affects people in the fifth decade of their lives onwards and is linked to the generalized reduced mobility in the mid back and neck of early osteoarthritis (degeneration or wear and tear).
The shoulder joint normally has a large range of movement. This achieved by having a shallow 'ball and socket ' joint with extensive muscular support to maintain integrity. All joints in the body are surrounded by a synovial capsule. This structure produces and contains synovial fluid which aids lubrication and nutrition in the joint. To enable a large range of movement in the shoulder the capsule must be lax with plenty of slack in it. When the arm is hanging by one's side the capsule bunches up into pleats under the joint. In adhesive capsulitis or frozen shoulder these pleats become inflammed and stick together causing the pain and restricting the range of movement. Adhesions (bands of abnormal tissue or scar tissue) form between the pleats leading to a persistent stiffness in the shoulder.
Adhesive capsulitis is often diagnosed clinically (ie without sending the patient of for tests). If a patient is in the likely age range (40-70 years of age) and complains of pain in the shoulder and stiffness, and is accompanied by the characteristic 'feel' of the joint during examination then frozen shoulder is often diagnosed. The patient will only be able to move the shoulder a few degrees to the side or in front and is seen to protect the joint. Occasionally arthrograms or MRI scans are performed to confirm the diagnosis.
There are three stages to frozen shoulder each lasting about six months.
This stage can have a slow or rapid onset and is characterised by pain. As the pain worsens the shoulder loses mobility and stiffens up as the capsule adheres together.
This is when the patient notices that the pain levels slowly start to recede. However the stiffness remains.
When the pain has all but gone the shoulder will slowly start to recover it's range of movement. It is unlikely that the full range of movement will fully return.
Adhesive capsulitis may respond to high doses of anti inflammatory medication in the early stages if there is a sudden onset. Often the shoulder itself will not respond to direct treatment in the early stages in which case careful management is important. This will often focus on maintaining and improving the health and range of movement of the surrounding areas (the rest of the shoulder girdle, the neck and mid back). This can be achieved through gentle stretches and exercises for the neck, rehabilitation exercises for the shoulder girdle and promoting relaxation. This not only takes some pressure of the shoulder but will also improve the well being and quality of the life of the patient during the recovery. Desk Therapy can be very useful in achieving these objectives and can compliment the treatment from an osteopath chiropractor or physiotherapist.
If these measures are unsuccessful then manipulation under anaesthetic (MUI) may be required. All treatment must be followed up with good rehabilitation exercises for the shoulder, gentle stretches and postural re education.
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