Frozen Shoulder (Adhesive Capsulitis)

Know more about the symptoms and types for frozen shoulder

Good morning everybody, I am doctor Rakesh Kumar, I am senior consultant in orthopedics in Apollo hospital, Jivan mala and MGS hospital. Today I am going to give health tips on frozen shoulder. Frozen shoulder is named as Adhesive Capsulitis. Adhesive Capsulitis is a condition in which contracted thickened joint capsules that seem to be drawn tightly around a humeral head in the absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule occurs. The underlying pathological change in adhesive capsulitis are sinonasal inflammation, with subsequent reactive capsular fibrosis, cytokines and metaloprotanysis have been implicated in the process but the initial triggering event in the cascades is unknown. Incidence is 2%, but several conditions are specified with increased incidence, includes gender—i.e more common in females, more common in older ages—between 40 to 70 years, 5 times more common in diabetes mellitus, cervical disc diseases, prolonged immobilization, hyperthyroidism, stroke, or myocardial infections, the presence of autoimmune disease and trauma.

Individuals between ages 40 to 70 are more commonly affected, approximately 70% patients are females. 20% to 30% of affected individuals develop adhesive capsulitis in the opposite shoulder. Frozen shoulder in patients who report no inciting event and with no abnormality are designated as primary whereas in patients with precipitant traumatic injuries are designated as secondary. We have noted that internal rotation frequently is lost in sleep followed by loss of fluctuation and external rotation, most often our patients can internally rotate only upto the sacrum, have 50% loss of external rotation and have less than 90 degree of abduction.

We include these patients in the diagnosis of frozen shoulder.

Primary frozen shoulder have three phases-

Phase 1 is a phase of pain, patients usually have a gradual onset of diffused shoulder pain which is progressive over weeks to months, the pain usually is worse at night, and is exacerbated by lying on the affected side as the patient uses the arm less leading to stiffness.

Phase 2 is stiffness, Patient seeks pain relief by restricting movements this heralds the beginning of stiffness phase which usually lasts for 4 to 12 months. Patients describe difficulty in activity of daily living, men have trouble getting to their wallets in their back pockets while females have trouble with fastening their brassieres.

Phase 3 is pain thawing phase, this phase lasts for weeks or months. And as motion increases pain diminishes without treatment other than benign neglect motion return is gradual in most but may never objectively return to normal. Although most patients subjectively feels near normal, they make adjustments in ways of performing activities of daily livings.

Treatments- Frozen shoulder has been considered as self limiting condition lasting 12 to 18 months without long term sick leave.  Approximately 10% of patients have long term problems. The best treatment of frozen shoulder is prevention. But early intervention is paramount. A good understanding of the pathological process by the patient and the physician also is important.

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