What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, is a painful condition affecting this important joint. Patients who suffer from it complain of joint stiffness, pain and limitation in movement. The causes of origin have not yet been fully clarified and often the disease arises without any apparent cause.
The frozen shoulder affects the capsule that surrounds the joint of the same name, thickening and healing the tissues that compose it.
The joint capsule is a sleeve of dense connective tissue that surrounds the joint, supporting and stabilizing the two bony heads that form it.
Under normal conditions the shoulder joint, thanks to its particular anatomical conformation, allows for a wide range of movements. However, when a patient develops a frozen shoulder, inexplicably, the capsule that surrounds it becomes stiff and forms adhesions. The loss of elasticity and the impairment of some anatomical structures with which it comes into contact cause the pain and limitation of the movements typical of the disease.
In particular, when suffering from frozen shoulder, the possibility of both active and passive movement decreases. In other words, this limitation is present both when the patient tries to actively move the arm and when it is moved by the doctor or therapist. The decrease in passive movement is one of the characteristics that distinguishes the frozen shoulder from other pathologies affecting this joint, such as a rotator cuff injury. The painful symptoms of the shoulder are, in fact, often confused with other pathologies such as calcific tendinopathy, rupture of the rotator cuff, arthritis or tendonitis. Another characteristic of this pathology is that joint limitation occurs on all planes. of movement and especially in external rotation.
Causes
As we have seen, most cases of frozen shoulder arise without any apparent cause. Sometimes the pathology develops following a traumatic injury to the shoulder (dislocation, fracture, contusion, etc.), even if it is an uncommon circumstance. However, predisposing risk factors emerge from the medical history of patients affected by this pathology.
- age: the frozen shoulder occurs more frequently in subjects aged between 40 and 60 years.
- Gender: Adhesive capsulitis mostly affects women, who have a double / triple risk of men
- Diabetes and thyroid dysfunction: Patients with these diseases are more at risk than the healthy population. In particular, about 10-20% of patients with type II diabetes and 35-40% of type I diabetics also suffer from frozen shoulder.
- Other systemic diseases (cardiovascular, Parckinson's disease, hypercholesterolemia, arthritis, etc.). have been linked with an increased risk of developing frozen shoulder.
- Previous history of shoulder pain and immobility: patients who suffer a shoulder injury develop frozen shoulder more frequently, especially if a long period of immobilization was followed after the injury, not followed by an adequate rehabilitation program
- Prolonged use of some medications
Symptoms
For further information: Frozen Shoulder Symptoms
A frozen shoulder causes a typical set of symptoms that can guide the doctor towards the diagnosis of the disease already at a clinical examination. The most important symptom is the limitation of movement associated with pain. This symptomatology, as we have seen, is however common to other diseases affecting the shoulder. Also for this reason it is very important to consult a doctor when one or more of the following symptoms appear:
- limitation of shoulder movement: strangely this disease affects the shoulder of the non-dominant limb more easily; sometimes it affects both shoulders at the same time (only in 10% of cases).
- Shoulder pain: this is usually a sharp and rather intense pain, sometimes associated with swelling and localized mainly in the upper external part of the shoulder.
- Pain and inability to perform normal daily activities such as shaving, fastening your bra or brushing your hair
- Pain that intensifies during the night's rest, especially if you fall asleep leaning on the side and on the painful shoulder.
The symptoms and the evolution of the pathology can be classified into three distinct phases:
- Cooling phase: this is the initial and most painful phase of the disease; the pain worsens over time and as this worsens the patient tends to limit its use more and more. In this phase the movements are limited but the shoulder still retains a good part of its mobility, losing it little by little; this phase generally lasts 6-12 weeks
- Freezing phase: there is an increase in joint stiffness while the pain tends to relieve; this phase can last 4-6 months
- Thawing phase: it is characterized by a gradual improvement of the condition that can last even more than a year
Diagnosis
The study of the symptoms combined with the patient's medical history and some specific tests normally allows the clinical diagnosis of the pathology. However, the doctor may decide to carry out further diagnostic investigations (such as X-rays) to ensure that there are no further specific lesions. or signs of osteoarthritis. MRI is hardly used, which is the most sensitive examination in evaluating other types of pathologies such as rotator cuff injury. Other tests, such as blood tests, can be performed to assess the presence of predisposing diseases such as hypercholesterolemia, diabetes and thyroid dysfunction.
Treatment and rehabilitation
The treatment of painful shoulder has as main objectives the reduction of pain and the regaining of lost mobility. Often the patient finds relief and perceives clear improvements after a few weeks, simply by following these tips.
- Stretching and mobilization exercises: to improve the range of motion of the shoulder and to minimize the loss of muscle tissue. These exercises should be performed several times a day (at least three), without straining the movements, initially under the supervision of a therapist, then also in complete autonomy
- Heat: can help loosen the joint block thanks to the increased local vasodilation. The application of moist heat (mud, paraffin, baths or packs) for ten minutes before starting the stretching exercises is particularly useful. If you have the possibility it would be very useful to carry out the active / passive mobilization exercises in a tub of hot water (35-36 ° C), just to fully exploit the beneficial effect of heat and movement.
- Other physical therapies such as ultrasound, laser therapy, and tens are sometimes employed to speed recovery
- Local cortisone injections help reduce pain in the early stages. In their place, oral or topical anti-inflammatory drugs can be used at this stage or during the flare-up of painful symptoms.
- Currently being tested: methods that provide for the "local injection of particular substances capable of" unblocking "adhesions in a short time
- Complementary and alternative medicine: osteopathic maneuvers and acupuncture, if performed by expert hands, can certainly bring considerable benefits by minimizing the risk of side effects
Abrupt and demanding movements such as lifting heavy loads with the sore arm should be avoided throughout the rehabilitation period. Usually the cold phase is the least sensitive to treatments, therefore the persistence of pain and reduced mobility in this phase should not demoralize the patient who, on the contrary, must continue and persist with the therapies undertaken. In the second period, characterized by greater instability, physical therapy is essential (some authors advise against it in the cooling phase).
Frozen Shoulder Exercises
WARNINGS: before performing these exercises to increase the mobility of the shoulder and improve the elasticity of the muscles and tendons that make up the rotator cuff, ask your doctor for advice. In particular, remember to always perform a general warm-up before starting the movements of stretching; wear comfortable clothing that does not impede movement; choose a relaxing environment and respect the correct breathing technique; avoid sudden movements and excessive stretching.If shoulder pain occurs during movements, stop exercising immediately and see a doctor if the pain is particularly severe or does not go away after a few days of rest.
Thanks to these measures, most patients suffering from frozen shoulder recover more or less completely the functionality of the joint within a year. However, it may happen that these treatments are completely ineffective.
If this happens the patient will have to go to a doctor to examine the possibility of surgery. In reality, the doctor may decide to perform a manipulation under anesthesia to break the adhesions that have caused the painful shoulder. This maneuver is however potentially harmful in how it can cause humeral fractures and injuries to the tendons that make up the rotator cuff.
The doctor may also decide to opt for the capsule release surgery to be performed under arthroscopic arthroscopy of the shoulder. In this case, after the operation, a passive micro-mobilization program associated with physical therapy should be started immediately to avoid immobilization favoring the reappearance of the disease.
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