Frozen Shoulder

The exact cause of adhesive capsulitis, commonly known as frozen shoulder, remains unclear, with no definitive link established to factors such as arm dominance, occupation, or athletic activity. Frozen shoulder can manifest in two primary forms: Primary (Idiopathic) and Secondary. Primary frozen shoulder is characterized by a global limitation of shoulder motion and a loss of compliance of the shoulder capsule, without any specific identifiable cause. Secondary frozen shoulder typically arises following surgery, injury, or prolonged immobilization, often in conjunction with conditions like subacromial impingement or a rotator cuff tear. Several predisposing factors have been associated with an increased risk of developing frozen shoulder, including diabetes, cardiac problems, elevated lipid levels, endocrine abnormalities, trauma, and shoulder, neck, or breast region surgery. These factors have been found to correlate with a higher incidence of frozen shoulder.

Frozen shoulder progresses through three stages, each lasting around 6 months, with variability from 3 to 9 months. Initially, during the freezing stage, patients experience slow-onset pain that worsens over time, accompanied by increasing stiffness in the shoulder joint. In the subsequent frozen stage, although shoulder pain tends to diminish, stiffness persists, making everyday activities challenging. Finally, in the thawing stage, shoulder motion gradually returns, and pain subsides. Despite treatment, individuals with adhesive capsulitis may endure symptoms for 6 months to 2 years as they traverse these stages, with some experiencing incomplete recovery of motion.

The most prevalent symptoms of frozen shoulder include chronic pain, joint weakness, and extreme stiffness resulting in limited motion. Patients commonly describe the pain as a constant dull ache, primarily felt in the outer portion of the shoulder, with some experiencing discomfort in the upper arm as well. Pain exacerbates with forceful movements and prevents affected individuals from sleeping on the affected side, often disrupting their sleep. The accompanying stiffness hampers daily activities such as dressing, reaching behind the back, combing hair, or lifting the arm overhead. Additionally, weakness in the rotator cuff tendons may occur due to tendinitis or tears. To diagnose frozen shoulder, healthcare providers rely on medical history, clinical examination, and relevant investigations. Medical history often reveals factors like diabetes mellitus, hypothyroidism, or prior trauma, with frozen shoulder more prevalent in females in their mid-forties to mid-fifties. A thorough examination of both shoulder joints assesses tender areas, range of motion, mobility limitations, rotator cuff tendon strength, and the status of nerves and blood vessels, with routine examination of the cervical spine. Findings are meticulously documented for subsequent comparison during follow-up visits. Investigations for frozen shoulder may include shoulder X-rays, which may be normal or reveal signs of subacromial impingement. MRI of the shoulder is another valuable tool, showing signs of inflammation and contraction in the capsule, particularly in the lower region (axillary pouch) and the rotator interval. The scan can also detect swollen bursae, inflamed or torn rotator cuff tendons, a swollen long head of biceps tendon, or the presence of pinching bony spurs.

Frozen shoulder, a condition marked by chronic pain and restricted mobility, often resolves over 1 to 2 years, but persistent discomfort and limited movement may prompt treatment. The approach depends on pain severity, stiffness, and disease stage. Non-surgical methods, like rest, medication, injections, and physiotherapy, aim to alleviate pain, restore range of motion, and enhance function. Should symptoms persist despite these efforts, arthroscopic capsular release may be recommended. This surgical procedure involves precisely cutting thickened and contracted shoulder tissues using specialized tools, offering immediate improvements in movement and pain relief. Early intervention has shown significant benefits, facilitating faster recovery and return to normal activities.