A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion (active range of motion), but also when the doctor attempts to move the joint fully while the patient relaxes (passive range of motion). A frozen shoulder is also referred to as adhesive capsulitis.
Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Any injury to the shoulder can lead to frozen shoulder, including tendinitis, bursitis, and rotator cuff injury.
Frozen shoulder occurs more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder.
This condition has been described in three phases, so the symptoms will differ depending on the phase of the condition”
- The Painful Phase: Gradual onset of aching shoulder, developing widespread pain, often worst at night and when lying on the affected side. This phase can last anywhere between 2-9 months.
- The Stiffening Phase: Stiffness starts to become a problem, pain level usually does not alter, difficulty with normal daily tasks such as dressing, preparing food, carrying bags, working, muscle wastage may be evident due to lack of use .This stage can last between 4-12 months
- The Thawing Phase: Gradual improvement in range of movement, gradual decrease in pain, although it may re-appear as stiffness eases. This stage can last between 5-12 months
The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. Diligent physical therapy is often a key, and can include ultrasound, electric stimulation, range-of-motion exercise, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.
Physical therapists can help a patient develop a stretching and exercise program, and also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. It is important that patients perform their stretches and exercise several times daily–not only when working with the therapist.
It is very important for people with a frozen shoulder to avoid re-injuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.
If you have frozen shoulder or other shoulder pain, be sure to have a full evaluation by a multidisciplinary healthcare team to help you decide on the best approach for you condition.
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