17 Feb Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is characterized by spontaneous severe shoulder pain with a gradually more limited range of motion of the shoulder over time. The symptoms are usually only in one shoulder, more likely the non-dominant shoulder. Frozen shoulder commonly occurs following shoulder injuries such as a rotator cuff tear or shoulder surgery. Those with diabetes mellitus, thyroid disease, prolonged immobilization, or stroke are also at higher risk for developing frozen shoulder. Frozen shoulder most commonly occurs between the ages of fifty and sixty, and more often in women than men.
Stages of Frozen Shoulder
Frozen shoulder is a chronic condition that can resolve on its own over a course of two to three years. The clinical manifestations of frozen shoulder progress through three phases. The first phase includes a severe shoulder pain that limits activities of daily living and is worse at night, and stiffness that increases over a two to nine month time period. In the second phase, the pain typically goes away, but the stiffness and limited range of motion are still prominent for four to two months. The third phase or recovery phase includes a slow return of the range of motion over a period of five to twenty four months.
Diagnosis of Frozen Shoulder
For those that present to a physician with frozen shoulder, it is primarily a clinical diagnosis. The history and progression of the shoulder pain can indicate a diagnosis of frozen shoulder. The physical exam will reveal a range of motion of the shoulder that is obviously limited in comparison to the contralateral shoulder. The physician may elect to do an injection into the shoulder – if the pain and stiffness does not improve with the injection, it is highly suspicious for frozen shoulder. Imaging of the shoulder, including x-ray, typically appears normal in the case of frozen shoulder, so it is not always necessary to obtain an image of the joint. An ultrasound study may also be used to evaluate the shoulder for changes in the soft tissues that are consistent with frozen shoulder and to inspect the rotator cuff for any injury.
Treatment of Frozen Shoulder
The treatment of frozen shoulder includes thorough education of the disease process to understand the treatment is a long process – but frozen shoulder is curable. Ibuprofen and acetaminophen are appropriate for pain as needed, especially during the first phase of frozen shoulder.
Physical therapy and chiropractor therapy may be useful in managing the range of motion through stretching and maintaining strength in all of the muscles around the shoulder joint. Studies have shown that an adjustment by the chiropractor can improve range of motion by fifty percent on the first visit and significantly decrease pain.
Patients should continue shoulder exercises on a daily basis and can provide heat therapy to the affected shoulder for the best results. Steroid injections into the joint can also be a suitable option to decrease inflammation.
If conservative interventions show no improvement after ten to twelve months, the patient should be referred to orthopedic surgery.
Frozen shoulder is a frustrating and slow healing process that may take months to years to return to full range of motion so collaborating with health professionals and commitment to daily treatment is important for a faster recovery.