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Frozen Shoulder What is it?

What is Frozen Shoulder?

 

 

Do you have frozen shoulder or has someone in your family or one of your friends been told they have frozen shoulder and you want to know what it is? In this video I answer that question.

Introduction
Frozen shoulder is a self limited condition that resolves of its own accord with more than half of patients regaining all their range of motion. It has a distinct relationship to diabetes. As we don’t know what causes frozen shoulder their is no cure however we can treat the symptoms.

For more information about Frozen Shoulder

For more information regarding surgery for Frozen Shoulder Arthroscopic Release

 

Discussion
Frozen Shoulder is an unusual condition as it only affects the shoulder. It is also called adhesive capsulitis. There is no similar condition that affects other large joints in the body.

We don’t understand what causes frozen shoulder. It is a disorder that affects the capsule or lining membrane of the shoulder joint. All joints have a lining capsule.

The condition often occurs spontaneously and it starts with inflammation of the shoulder joint capsule. This is called capsulitis. If you place an arthroscope into the shoulder joint at this stage the lining of the shoulder joint instead of appearing a healthy shiny white is red and hyperaemic due to the increase in blood to the capsule as part of that inflammation.

The shoulder joint is inflamed and angry and there is a lot of synovitis in the joint associated with this process.

This inflammatory process is typically very painful with the shoulder aching particularly at night time and it is often very hard for people to get comfortable or to sleep with the shoulder like this.

The inflamed capsule then starts to change from a thin pliable membrane to become thick fibrous and contracted. The capsule can go from being a millimetre or so thick to being 5 or 6mm thick.

When this happens the shoulder becomes very stiff. This isn’t a stiffness where the limitation in movement is due to pain such as with bad bursitis or mild to moderate arthritis rather it is a physical limitation to movement due to the contracture of the shoulder capsule.

The limitation in movement occurs in all directions. Whereas with other common shoulder conditions such as impingement the limitation in movement is pain related and occurs when lifting the arm away from the body or abduction and not with rotation.

After some months the inflammation resolves and the patient is left with a stiff shoulder that is no longer as painful but is stiff due to the thickened and contracted shoulder capsule. This is called the frozen phase.

When severe the limitation in range of motion in the affected shoulder can be extreme and bad enough to prevent patients from working or doing their normal recreation and home activities.

Eventually the thickening of the shoulder capsule starts to resolve and go back towards what it used to be like. As it does the movement returns to the shoulder. This is called the thawing phase.

Several studies have shown that not everyone makes a full recovery from frozen shoulder. A paper published in the Journal of Bone & Joint Surgery in 1992 by Shaffer et al. found that 60% of the patients they looked at 7 years after developing frozen shoulder had some restriction in their movement and some mild pain. Although, only 11% had a mild functional limitation. Hand et al in their paper published in 2008 in the Journal of Shoulder and Elbow Surgery, reported that of the patients they looked at an average of 4.4 years after contracting frozen shoulder 41% had mild to moderate symptoms with 6% having severe ongoing symptoms and functional loss. Wong and his coauthors in 2017 published a systematic review of the scientific literature in the journal Physiotherapy and similarly concluded that full recovery was not consistently achieved.

Frozen shoulder frequently occurs spontaneously, however, it often occurs following a relatively minor injury and is relatively commonly precipitated by shoulder surgery. When frozen shoulder occurs following trauma or surgery it tends to be less severe and shorter lived.

Frozen shoulder frequently occurs in people who are diabetics. Frozen shoulder affects approximately 1 to 2% of the normal population. However, it affects 10 to 20% of the diabetic population. Patients who have diabetes typically have more severe frozen shoulder that lasts longer and is more resistant to treatment. There is a less significant relationship to thyroid disorders. People between 40 to 60 years old are the most at risk of frozen shoulder and it affects women much more commonly than men.

Conclusion
In summary, frozen shoulder is a common condition that only affects the shoulder. It is characterised by a capsulitis of the shoulder joint capsule which becomes dramatically thickened and contracted with affected people experiencing the symptoms of pain and stiffness. It is much more common in diabetics and in women between the ages of 40 to 60 years old. It is a self limited condition that resolves of its own accord and because of this it does not necessarily require treatment. It can take several years for the condition to resolve and it does not resolve completely in everyone.

If you are concerned that you may have frozen shoulder you can see your general practitioner and they may refer you to an orthopaedic surgeon to diagnose your shoulder condition. You may also want to consider having a fasting blood glucose test to check you don’t have diabetes.

For more information about Frozen Shoulder

For more information regarding surgery for Frozen Shoulder Arthroscopic Release