Frozen Shoulder or Adhesive Capsulitis:
- Also known as Frozen Shoulder Syndrome (FSS).
- Condition involving pain and immobility (stiffness) of the shoulder.
- Progressive condition.
Adhesive capsulatus is actually broken down into two types:
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| Types of Adhesive Capsulitis |
one is known as primary adhesive capsulatus. which is going to be adhesive capsulators that the underlying cause is not known. which means that it's idiopathic or secondary adhesive capsulated. which is going to be due to some other underlying cause.
We're going to discuss about a wide variety of causes. So frozen shoulder syndrome is more likely to affect patients between the ages of 40 to 60.
The lifetime estimate of having this condition is 2 to 5 percent of the gender population. Females are more likely to be affected with this condition than male patients. It is roughly four times higher likely in females compared to males.
Epidemiology:
- More likely to affect patient between the age of 40-60.
- Lifetime estimate of 2-5% of the general population.
- Females are more likely to be affected ( 4x higher likelihood ).
Adhesive Capsulitis: Etiologies
( Secondary Adhesive Capsulitis )
- Prolonged shoulder immobilization.
- Diabetic.
- Hyperthyroidism.
- Parkinson's diseases.
- Stroke.
- Shoulder injury.
- Complex regional pain syndrome.
- Cancer.
Let's talk about some of the etiologies of secondary adhesive capsulators. So as, mentioned before primary adhesive capsulatis is where the underlying cause is not known. So it's idiopathic.
Secondary adhesive capsulatus has a wide variety of causes. One of them is going to be prolonged shoulder immobilization. Which means that the shoulder is not going to be moved for a very long period of time.
This is actually a very important cause of this condition. We can also see diabetes being an important underlying cause of adhesive capsulitis as well and this is considered to be an independent risk factor.
It's actually shown to increase the likelihood of having adhesive capsulitis by nearly five times. So it's five times more likely to occur in diabetic patients than non-diabetic patients.
Having hyperthyroidism which is a high functioning thyroid is also an Associated cause of this condition.
Parkinson's disease is also another potential underlying cause. We can also see having a stroke as an important Associated factor with adhesive capsulatus.
We can also see having a shoulder injury being an important cause of this condition as well and all three of these can lead to reduced mobility of the shoulder which increases likely that of having this condition and another one is going to be complex regional pain syndrome which is another Associated Factor as well and then having cancer can also be an underlying cause of secondary adhesive capsulators.
Adhesive Capsulitis: Clinical features
- The freezing phase
- The Frozen phase
- The thawing phase
so let's talk about the clinical features of adhesive capsulitis. Before we talk about the clinical features it's important to note that the non-dominant shoulder is more likely to be affected. This condition is going to be unilateral meaning that it's only going to affect one shoulder as opposed to both shoulders.
Although bilateral cases can occur in rare instances and again often this can be related to mobility issues. The non-dominant shoulder being less utilized and what will be the Hallmark findings in adhesive capsulators is pain and stiffening and they're going to occur in a particular pattern. Which we're going to talk about here in a moment So, there is three phases of adhesive capsulatis
1. The freezing phase of adhesive Capsulitis
- Onset occurs slowly over time.
- Pain progressively worsens.
- - Diffuse.
- - Shoulder and upper arm.
- Occurs over 6-9 months.
So in the freezing phase as his name implies it occurs slowly over time and it involves pain which progressively worsens and his pain is going to be diffuse. It's going to be located over the outer shoulder and the upper arm. It's going to often occur over six to nine months or up to nine months. So this is going to be the phase where we're going to see inflammation of the joint capsule.
2.The Frozen phase of adhesive Capsulitis
- Characterized by progressive stiffening.
- - Severe restriction of movement.
- - External rotation limited.
- Pain may improve.
- Occurs over 4-10 months.
Now in the Frozen phase we start to see a progressive stiffening. This corresponds with the pathophysiology where the information starts to reduce but it's going to lead to this fibrosis of that joint capsule.
The joint capsule becomes harder to move and it becomes stiff. So this is often going to lead to severe restriction of movement. Especially external rotation is going to be limited.
So if you're trying to externally rotate your arm it's very difficult. it becomes very stiff now in this phase because it corresponds to that reduction in inflammation pain can actually improve in this phase. This phase occurs over four to twenty months.
3.The thawing phase of adhesive Capsulitis
- Very slow and gradual resolution of symptoms.
- Range -of-moton of shoulder slowly improves.
- Residual pain resolves.
- Occurs over 5-26 months.
The last phase is going to be the thawing phase. This is going to be where there's going to be very slow and gradual resolution of symptoms. The range of motion of the shoulder slowly improves and there may be some residual pain. It's going to resolve in this phase and this is going to occur over 5 to 26 months.
Now these are on average the timelines for these phases and some cases it may differ but these are the general timelines as to when the patient goes through a freezing phase Frozen phase and thawing phase.
Adhesive Capsulitis: Diagnose
Clinical Diagnosis:
- Symptoms persist for at least 3 months.
- Other criteria suggest at least 1 month.
Radiological Imaging:
- X-ray.
- Musculoskeletal ultrasonography.
- Often normal in adhesive Capsulitis.
How do clinicians diagnose adhesive capsulated? This is going to be a clinical diagnosis so getting the history seeing that there was prolonged shoulder immobility is going to be very important or if the patient has diabetes and they have this characteristic progression and pattern of signs and symptoms that's going to be enough to make the diagnosis for the clinical diagnosis though symptoms must have persisted for at least three months.
So this is going to be important and some other criteria will suggest at least one month but the criteria for diagnosis is going to involve symptoms for many months.
So this is often going to be what's going to happen because again this is a long drawn out condition. Now radiological Imaging may be used in some cases.
X-ray can be used and musculoskeletal ultrasonography can be used in some cases. These are mostly going to be used to rule out other conditions as we see with adhesive capsulators these Imaging modalities are often going to be normal. So again it's used to rule out other conditions.
Adhesive Capsulitis: Treatment
Once the clinician has made the diagnosis how do they treat adhesive capsulitis?
- Self- limiting condition.
- Primary adhesive Capsulitis resolves within 9-18 months (upto 3 years).
- Secondary adhesive Capsulitis has poorer prognosis.
This is going to be a self-limiting condition so primary adhesive capsulated resolves on its own within 9 to 18 months up to three years on average and oftentimes secondary adhesive capsulatus has a poor prognosis so it may take longer or may be more difficult to fully resolve.
The treatments we're going to talk about here are going to be broken down into whether or not they're used in the freezing phase or the thawing phase.
Freezing phase: treatment
So, in the freezing phase pain management is going to be very important. Utilizing non-steroidal, anti-inflammatory drugs, NSAIDs like ibuprofen, Motrin, naproxen. These can all help with reducing some of the inflammation in the joint capsule but also reducing the pain which is going to be helpful in preventing further immobility.
If the patient has pain in that shoulder they often will not use that shoulder much and that can actually worsen the condition.
Another way of dealing with the pain can be a corticosteroid injection as well and then therapy is going to be important in the freezing phase.
So Physiotherapy doing passive and active range of motion exercises and all of this again has to do with the fact that movement improves resolution because of that pain and that limited use of the shoulder. This can lead to worsening thickening of the joint capsule and the reason is because some of the main causes of this condition are shoulder immobility.
When this condition starts you start to have pain in the shoulder and you're less likely to use it. This is actually going to lead to more immobility.If you're going to use the shoulder even less than you should and this is going to worsen that thickening of the joint capsule.
So the stiffness and the freezing of the shoulder is going to be worse. Pain management keeping the pain low so the patient uses their shoulder more. Then doing physiotherapy those range of motion exercises are going to be very important in this phase.
Pain management:
- Non-steroidal anti-inflammatories (NSAIDs)
- Corticosteroid injection
Therapy:
- Physiotherapy.
- - passive and active range-of-motion exercises.
- - movement improves resolution.
Thawing phase: treatment
Then the other treatment is going to occur during the thawing phase. So most cases are going to resolve slowly on their own. But if there is limited Improvement surgery may be utilized in limited cases. One surgery technique can be manipulation under anesthesia. so what happens is patient is put under anesthesia and then there is very rigorous movement of the shoulder to essentially break the shoulder capsule that thickened shoulder capsule that prevents movement. So this is one way of dealing with this condition and the other one is arthroscopic capsular release again breaking through that thickened capsule allowing the patient to be able to move their arm or shoulder properly. These are the treatment methods for frozen shoulder or adhesive capsulitis.
Most Cases resolve slowly on their own.
If limited improvement:
- Surgery may be utilized in limited cases.
- - Manipulation under anesthesia.
- - Arthroscopic capsular release.
These was about Frozen Shoulder ( Adhesive Capsulitis). If you have any question about Adhesive Capsulitis please comment us. We will try out best to provide you an answer. Thank you.
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