What is a frozen shoulder?
The frozen shoulder is a symptom complex consisting of pain and restricted movement of the shoulder. Unfortunately, many shoulder disorders are accompanied precisely by both pain and restricted movement, which has meant that the term is often used interchangeably. The genuine frozen shoulder is, however, relatively rare, and in many cases can be relatively easily separated from other morbid conditions in the shoulder.
Frozen shoulder is caused by inflammation (that is, sterile inflammation) of the joint capsule of the shoulder. Sterile inflammation is inflammation that does not involve microorganisms from the outside, but is limited to a specific area. The joint capsule of the shoulder is thereby raised, tense, and sticks together with the underlying shoulder bones, resulting in reduced mobility of the shoulder.
Why do you get a frozen shoulder?
Frozen shoulder can occur after a shoulder injury and after shoulder surgery, but in the vast majority of cases there is no known trigger.
Frozen shoulder affects two to five percent of the population. The condition has a predilection for people aged 40 and 60, and women are affected slightly more often than men. It is five times as frequent in people with diabetes than in the upper part of the population. It is also seen more often with elevated cholesterol, with metabolic disorders, and with cancer in the shoulder, breast, lungs and lymph nodes. About 15 percent get the disorder on both sides.
What are the symptoms and causes of a frozen shoulder?
The condition can be divided into 3 phases:
1st phase of 2-6 months which is characterized by:
Pain diffusely localized to the shoulder with radiation to the upper arm.
Worsening of the pain at night and with movement.
Movement restriction of the shoulder in all directions.
2nd phase of 6-12 months with:
Increasing limitation of movement of the shoulder.
The pain subsides.
3rd phase of 2-3 years with:
The pain is now gone.
Gradual recovery of mobility.
The prognosis is good. Only 10% have continued problems after 4 years.
Diagnose frozen shoulder
The diagnosis rests on the medical history and the medical examination.
There must have been pain for at least 3 weeks
There is restriction of movement of the shoulder in all directions. In particular, there is restricted outward rotation of the shoulder, a condition that often distinguishes the frozen shoulder from other morbid conditions in the shoulder.
Other morbid conditions in the shoulder must be ruled out
The X-ray is normal, or shows conditions that cannot explain the limitation of movement.
On ultrasound scanning and magnetic scanning (MR scanning), thickening of the front part of the capsule and of a ligament (ligamentum coraco-humeral) can be seen.
Blood tests may reveal conditions consistent with diabetes or high cholesterol, but are otherwise normal.
Adhesive capsulitis – pain and loss of motion
Adhesive capsulitis, also known as frozen shoulder, is a condition that causes pain and stiffness in the shoulder. The cause of adhesive capsulitis is not fully understood, but it is thought to be caused by inflammation and scarring in the shoulder joint. Symptoms include pain, stiffness, and limited range of motion. Treatment for adhesive capsulitis includes non-steroidal anti-inflammatory drugs (NSAIDs), Physical Therapy (PT), and surgery. PT can help improve range of motion and reduce pain. Surgery may be necessary if other treatments fail to improve symptoms.
How to treat a frozen shoulder? risk factors
The treatment strategy mostly depends on how much pain you have, and it varies a lot. Some have constant severe pain that worsens with the slightest exertion and that disturbs sleep at night. Others have no significant pain. Most are somewhere in between. For most people, it is the pain that is the main limiting factor, unless you have activities that require you to be able to lift the shoulder normally.
Phase 1 and 2:
As far as possible, you must avoid all actions that provoke or worsen the pain. This can involve full or partial sick leave, depending on how much pain you have and what job you have.
Blockades with adrenal hormones have been shown to have a beneficial effect on the pain, so that phase 1 is shortened. Blockades are given until the pain is no longer a problem. The adrenal cortex hormone is effective for up to 6 weeks after injection. Depending on the effect and how much adrenal cortex hormone is given, the injections are typically repeated after 4-6 weeks.
NSAIDs (also called gout tablets), taken for 4 weeks, provide pain relief, but not better mobility. The tablets are associated with a risk of stomach ulcers, and they also have possible side effects for the heart and kidneys.
Treatment with anti-inflammatory medication prednisolone (adrenocortical hormone) 30 mg daily for 3 weeks. However, there are a number of possible side effects associated with this, including osteoporosis.
Blockades with local anesthetic alone can be given around one of the nerves supplying the shoulder (in this case it is the suprascapular nerve). Blockades can be given up to 5 times, approximately 1 week apart.
Other treatment for shoulder problems
Acupuncture generally has a good effect on shoulder pain and can be tried when treating a frozen shoulder.
Referral to physiotherapy, with a view to starting exercises. In Phase 1, the exercises consist of movement exercises that must not provoke pain. The patients who have a lot of pain in phase 1 will often not benefit from exercises before phase 2.
In phase 2, the exercises are aimed at improving movement.
Shoulder Pain Surgery:
Binocular surgery of the shoulder can be offered for continued severe pain in phase 1 and 2, or insufficient result after 6 months, despite adequate non-operative treatment, including adrenal cortical hormone injections. The intervention can also be offered in rare cases where the shoulder continues to exhibit pronounced movement restriction in phase 3.
During the intervention, the capsule is loosened and tight ligaments are removed. At the same time, space is created by removing the mucous membrane and part of the shoulder’s bony ceiling (acromioplasty). After the operation, exercises are started under physiotherapeutic guidance.
Physiotherapy with a focus on movement training combined with strength exercises.
Binocular surgery as described above, in the rare cases where the shoulder continues to exhibit pronounced movement restriction.
What can you do yourself?
See a doctor to get the correct diagnosis.
As far as possible, stay away from the actions that provoke the pain.
If you have been too active and provoked pain, you can try putting ice on the shoulder. Special ice packs, a bag of ice cubes, or a bag of frozen peas can be used. The ice must not be placed directly on the skin. Put a cloth between the ice and the skin so that frostbite does not occur in the skin. Ice is applied for 20 minutes.
In phases 2 and 3, exercises can be started, preferably under the guidance of a physical therapist.
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Vogue Health Team