DESCRIPTION AND SYMPTOMS
WHAT IS ADHESIVE CAPSULITIS (FROZEN SHOULDER)?
Often referred to as Frozen Shoulder by both patients and doctors alike because of its ability to easily and visually describe the condition, Adhesive Capsulitis is characterized by:
- Severe pain in the shoulder that is often worse at night and usually begins suddenly without good cause or after insignificant trauma.
- Gradual stiffness in the joint that results in difficulty or inability to move the shoulder with relative normality (hence its name “frozen shoulder”)”
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- An alteration in the joint capsule consisting of a retraction of the shoulder’s posterior capsule, although the cause of these capsule changes is unknown. In most cases of Frozen Shoulder, the patient describes a minor trauma.
- In some patients this shoulder stiffness may be secondary. That is, it happens after having undergone surgery, after suffering a humerus fracture, etc.
Other shoulder injuries:
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WHAT ARE THE SYMPTOMS OF FROZEN SHOULDER AND HOW IS IT DIAGNOSED?
Pain that is dull, fixed and continuous. Typically, this pain occurs more insistently at night and is more evident in the first stage of the disease.- Stiffness to the point of greatly limiting arm movements for simple and daily activities (such as your combing hair). The first movement that is lost and the last one that is usually regained is passive external rotation.
Pain that is dull, fixed and continuous. Typically, this pain occurs more insistently at night and is more evident in the first stage of the disease.In the exploration of the frozen shoulder, the global assessment of the joint is important. That is, the glenohumeral and scapulothoracic joints should be explored both actively and passively.
The diagnosis that will have to be confirmed by performing various complementary tests using an MRI to exclude other causes of stiffness.
IF THE INJURY IS NOT TREATED IN TIME
If frozen shoulder isn’t treated, it can lead to serious consequences:
Work
An injury in this area limits the performance of any job. Pain and stiffness limit the patient’s job performance.
Sport
If you continue to play sports and do not go to a specialist, the injury can get worse. A specific rehabilitation program must be established.
Stiffness
This injury means what is a nearly entire loss of the shoulder’s functional mobility.
HOW IS FROZEN SHOULDER TREATED?
CONSERVATIVE TREATMENT
Initially, frozen shoulder is treated conservatively. Physiotherapy, corticosteroid injections at the rotator interval level, and a home exercise routine are our basic tools. With proper treatment, mobility of the shoulder is often restored.
Physical therapy should be daily and be painless. Recovery time can be long, therefore it is necessary to be consistent and patient during recovery. Some patients may take between 6 months to 2 years to recover, especially those with poor prognostic factors, such as diabetes.
Ultrasound-guided corticosteroid injections at the rotator interval level are very effective if performed in the acute phase of the disease. But in the event that conservative treatment does not give the expected results after 6-12 months, arthroscopic surgery should be performed.
SURGICAL TREATMENT
Arthroscopic treatment of frozen shoulder consists of a procedure called arthroscopic arthrolysis, or the release of the joint capsule, where the surgeon removes excess scar tissue in the shoulder joint to release it and restore full mobility to the shoulder. It is performed with the help of a camera and small incisions.
After surgery, the patient must undergo a specific postoperative rehabilitation program so as not to lose the mobility achieved in the operating room
FREQUENTLY ASKED QUESTIONS
How is arthroscopic surgery for frozen shoulder performed?
The surgeon will make a small incision in the shoulder and insert an arthroscope (camera). After this, tiny instruments are inserted into other small incisions in order for the doctor to cut and remove the scar tissue that is causing frozen shoulder.
What is the recuperation like after an arthroscopic surgery for frozen shoulder?
Once the patient has recovered from the anesthesia, they can go home, following the instructions below:
- Place ice on the inflamed area for the first 24-48 hours, at 20-30 minute intervals, without wetting the surgical wound.
- Sleep sitting up or in a reclining chair, placing a pillow behind your elbow.
- Take pain relievers as needed and instructed.
- Prevent new stiffness with immediate active and passive mobilization of the shoulder.
- Attend a follow-up appointment at the doctors in7 or 10 days to have your stitches removed.
- Undergo physiotherapy treatment. This postoperative physiotherapy is very important and must be carried out under professional supervision.
After the operation, you will experience less shoulder pain and will enjoy a better range of motion, although it will remain sore for a few weeks and you will need to follow physiotherapy treatment and home exercises.
Complete recovery can take from 3 to 6 months.
What are the possible complications following arthroscopic surgery for frozen shoulder?
Among the possible complications that may arise after arthroscopic surgery for adhesive capsulitis are:
- Stiffness in the shoulder joint
- Damage to nerves and blood vessels
- Shoulder manipulation fractures
How long does arthroscopic surgery for frozen shoulder take?
The length of time for an arthroscopic surgery to treat frozen shoulder varies depending on the specifics involved in the injury and the characteristics of the patient, but it does not usually exceed 45 to 60 minutes.
What are the stages or phases of frozen shoulder?
The frozen shoulder goes through three stages, or phases, in its evolution, with levels of stiffness and recovery varying from patient to patient. Traditionally, this disease has been described as self-limited, but duration is long:
- Painful (or “Freezing”) Phase: Range of motion begins to decrease as pain increases. Lasts from 6 to 9 weeks.
- Adhesive (or “Frozen”) Phase: The pain begins to subside but the stiffness remains. Daily activities are difficult. Lasts 4 to 6 months.
- Recovery (or “Thawing”) Phase: The stiffness is slowly decreasing and full recovery of movement and strength is experienced. Lasts 6 months to 2 years.
REFERENCES
Whelton C et al.Review of diabetic frozen shoulder. Eur J Orthop Surg Traumatol. 2018 Apr;28(3):363-371. doi: 10.1007/s00590-017-2068-8. PMID:29094212
Wu WT et al Effectiveness of Glenohumeral Joint Dilatation for Treatment of Frozen Shoulder:A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sci Rep. 2017 Sep 5;7(1):10507. doi: 10.1038/s41598-017-10895-w.
Kim YS et at. Comparison of high- and low-dose intra-articular triamcinolone acetonide injection for treatment of primary shoulder stiffness: a prospective and randomized trial. J Shoulder Elbow Surg. Feb;26(2):209-215. doi: 10.1016/j.jse.2016.09.034.
Kitridis D. Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis. Am J Sports Med. 2019 Feb 8:363546518823337. doi: 10.1177/0363546518823337
Page MJ et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014 Aug 26;(8):CD011275. doi: 10.1002/14651858.CD011275.
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