FROZEN SHOULDER 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, and 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. 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, thyroid disease, and heart disease. Treatment may be painful and taxing and consists of physical therapy, occupational therapy, Chiropractic, 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 NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two 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. Signs and diagnosis One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is external rotation of the shoulder. People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion, or if bumped. A physical therapist or chiropractor may suspect the patient has a frozen shoulder if a physical examination reveals limited shoulder movement. Frozen shoulder can be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder). An arthrogram or an MRI scan may confirm the diagnosis, though in practice this is rarely required. The normal course of a frozen shoulder has been described as having three stages: Stage one: The freezing or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion. Stage two: The frozen or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts from four to nine months. Stage three: The thawing or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.
Posted on: Thu, 23 Jan 2014 10:26:53 +0000
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