Frozen shoulder or stiff shoulder

Source: Adhesive capsulitis of shoulder. From Wikipedia, the free encyclopedia

Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, when the weather is colder, and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.

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This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.

 

In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems sleeping for extended periods due to pain that is worse at night and restricted movement/positions, . The condition also can lead to depression, pain, and problems in the neck and back.

Risk factors for frozen shoulder include diabetes, stroke, accidents, lung disease, connective tissue disorders, and heart disease. The condition very rarely appears in people under 40.

Treatment may be painful and taxing and consists of physical therapy, medication, massage therapy, hydrodilatation or surgery. A doctor may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAID‘s. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two 2 years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.

Management of this disorder focuses on_

  1. restoring joint movement
  2. and reducing shoulder pain.

Usually, it begins with _

  1. nonsteroidal anti-inflammatory drugs (NSAIDs)
  2. and the application of heat,
  3. followed by gentle stretching exercises.

which may be performed in the home with the help of a physical therapist. In some cases transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses.

The next step often involves one or a series of steroid injections (up to six) such as Methylprednisolone. Treatment may be needed for several months. Injections are usually given under radiological guidance, with either fluoroscopy, ultrasound or computed tomography (CT). Radiological guidance is utilized so that the needle is safely and accurately guided into the shoulder joint.

Cortisone is injected into the joint in order to suppress the inflammation that is characteristic of this condition.

The shoulder capsule may also be stretched by injecting normal saline, often to the point of rupturing the capsule in order to alleviate the pain and loss of motion due to its contraction (hydrodilatation or distension arthrography); however research in 2008 has questioned the benefit of hydrodilatation as giving no statistical benefit over injecting cortisone alone.[3]

If these measures are unsuccessful the doctor may recommend manipulation of the shoulder under general anesthesia to break up the adhesions.

Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy[4]. Surgery to correct other problems with the shoulder, e.g., subacromial impingement or rotator cuff rupture may also be needed.

Physiotherapy may include massage therapy and daily extensive stretching, sometimes after warming/heating the shoulder.

Alternative medicine treatments include:

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