Frozen Shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. When the tissues in your shoulder joint become thicker and tighter, scar tissue develops over time. As a result, your shoulder joint doesn’t have enough space to rotate properly. Common symptoms include swelling, pain, and stiffness.

One becomes aware of a frozen shoulder when it begins to hurt. The pain then causes you to limit your movement. Moving the shoulder less and less increases its stiffness. Before long, you find that you can’t move your shoulder as you once did. Reaching for an item on a high shelf becomes difficult, if not impossible. When it’s severe, you might not be able to do everyday tasks that involve shoulder movement such as dressing, reaching behind bra clasps, wallets, and back itches. About two-thirds of the patients are women.

Who Is at Risk for a Frozen Shoulder?
If one has a hormonal imbalance, diabetes, or a weakened immune system, you may be prone to joint inflammation. A long period of inactivity due to an injury, illness, or surgery also makes one more vulnerable to inflammation and adhesions, which are bands of stiff tissue. In serious cases, scar tissue may form. The condition is more likely to occur in middle age and is more common in women. If you have diabetes, your risk for the condition is three times greater.

Others at risk include:
• People who must wear a shoulder sling for a long period after an injury or surgery
• People who remain still for long periods of time due to a recent stroke or surgery
• People with thyroid disorders

How Is a Frozen Shoulder Diagnosed?
Frozen shoulder is technically a diagnosis of exclusion, which means that it can only be diagnosed by eliminating all other possibilities. The defining symptoms of frozen shoulder are:
• Reduced mobility of a shoulder joint in three stages:(1) Freezing: Increasingly painful restricted movement. (2) Frozen: Restricted but relatively painless. (3) Thawing: The gradual return of movement, for some lucky people

• The first movements to go are usually rotations especially external rotation and later behind the back.

• Night pain, especially when lying on the affected side.

• A sensitive coracoid process and arm

But, in principle, it’s important to understand that any/all of those symptoms could in theory be caused by other problems. Fortunately, frozen shoulders usually thaw, but it can take months, years, or even be permanent.

Do you need an X-ray?
An x-ray is potentially helpful for excluding shoulder joint arthritis or scary causes of pain like a tumour.

Magnetic resonance imaging (MRI) and ultrasound
These studies can provide better images of soft tissues. They are not required to diagnose frozen shoulder; however, they may help to identify other problems in your shoulder, such as a torn rotator cuff.

Other shoulder problems that could be confused with Frozen shoulder are presented roughly in order of how much they can seem like frozen shoulder:

Rotator cuff tendinopathy or tear: A rotator cuff is a group of four muscles that surrounds the shoulder joint like a “cuff,” and that cuff is anatomically overlapping the joint capsule that gets inflamed in the frozen shoulder — which is why rotator cuff problems can be difficult to distinguish from frozen shoulder. Rotator cuff abnormalities and lesions increase steadily later in life.

Subacromial and subdeltoid bursitis is closely related to rotator cuff tendinitis, but instead of tendons, they affect bursae (the anatomical padding between tendons and other structures).

Arthritis of the big shoulder joint mostly occurs beyond middle age, and usually develops more slowly-but-steadily. An X-ray will show clear signs of joint degeneration that won’t be seen with adhesive capsulitis.

Acromioclavicular arthropathy is degeneration of the joint at the outside end of the collar bone. It does not really affect shoulder range of motion, the pain is more specific to that superficial joint, and it’s usually associated with a history of overuse and injury, usually athletic.

Tendinitis of the biceps tendon: Tenderness sticks to the front of the shoulder with this condition. Biceps contraction is painful, but other movements are normal.

Autoimmune diseases like lupus or rheumatoid arthritis can affect many joints in the body, including the shoulder — but they usually do affect multiple joints, and cause several other health problems that obviously set them apart.

Cancer is one of the least likely causes of frozen-shoulder pain, but a tumor in or near the joint is a possibility. Watch out for other signs of failing health, especially night sweats and weight loss and shortness of breath.

How Is Frozen Shoulder Treated?

A combination of the following can speed up your recovery:
• Physical therapy
• Medication
• Home Care
• Surgery

Physical Therapy
Physical therapy is the most common treatment for a frozen shoulder. The goal is to stretch and strengthen your shoulder joint and regain the lost motion. It can take anywhere from a few weeks to months to see progress. The same home exercise program of a gentle range of motion exercises is important.

To treat the pain and reduce your joint inflammation, you may be given an anti-inflammatory medications. A steroid injection is rarely required in your shoulder joint if the pain is out of proportion and not responding to physical therapy and medications.

Home Care
Placing an ice pack on your shoulder for 15 minutes at a time several times per day can help to decrease pain. This should be always combined with self starches and advised physical therapy. Most people with a frozen shoulder can improve their condition without surgery.

If physical therapy doesn’t improve your condition, surgery is an option. Arthroscopic surgery. This type of surgery involves making a small cut in your shoulder and using a camera called an “arthroscope” to remove scar tissue or release it. This allows the shoulder to recover its lost motion. Surgery is usually done on an outpatient basis. Your stitches will most likely be removed after 10 days. Postoperative physical therapy is usually required as well. Many patients have their full range of motion back within two-three months.

The writer is a specialized orthopaedic surgeon in the shoulder, knee, and sports injuries. He is among the best Shoulder, Knee, and Joint replacement surgeons in Pune who specializes in Arthroscopy surgeries, replacement surgeries, and Sports Ligament Injuries.

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