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Frozen Shoulder Syndrome

What is Frozen Shoulder Syndrome (Adhesive Capsulitis)?

The shoulder region consists of three bones. These bones are the upper arm, scapula, and collarbone. The name of the tissue that surrounds the shoulder joint and holds everything together is the shoulder capsule.
Frozen shoulder is also known as adhesive capsulitis.

Frozen shoulder is a condition that should be treated because it reduces the quality of life.
It is a serious health problem that restricts people’s movements and manifests itself with pain symptoms.
Frozen shoulder discomfort, which occurs as a result of thickening, narrowing, inflammation of the capsule of the shoulder joint or a decrease in intra-articular fluid, makes the capsule thick and tight, making it difficult to move.

Symptoms usually begin gradually. And it gets worse over time. Although it usually occurs in one shoulder, it can be seen in both shoulders.

What Causes Frozen Shoulder Syndrome (Adhesive Capsulitis)?

  • Frozen shoulder syndrome, which is characterized by severe pain, can occur due to diseases such as bursitis and arthrosis.
  • As a result of prolonged immobility of the shoulder joint, it may cause damage to the soft tissues and retraction of the joint capsule.
  • Any systemic disease such as chronic obstructive pulmonary disease, heart attack, thyroid disease also has an important role in the emergence of this syndrome.
  • Having diabetes makes a person an easy target for this syndrome. Frozen shoulder syndrome is seen in one out of every 5 people in diabetics.
  • Keeping the shoulder fixed for a long time as a result of traumas such as bumps and falls can trigger this disease.
  • Shoulder calcification is also among the causes of freezing shoulder syndrome.

It should not be forgotten that most of the patients who develop frozen shoulder today are people who are under intense stress or have sleep disorders.

Hormonal imbalances such as menstrual irregularity and menopause in women constitute a risk group for frozen shoulder.

What are the Symptoms of Frozen Shoulder Syndrome (Adhesive Capsulitis)?

Frozen shoulder syndrome is a condition characterized by pain and limitation of movement.
Severe shoulder pain that does not go away is felt even during daily activities such as dressing and eating.

Symptoms of frozen shoulder syndrome:

  • Shoulder pain felt even at rest
  • Pain that increases when lying on the shoulder during sleep
  • Restriction of shoulder movements
  • Difficulty in activities of daily living
  • Pain, strain when lifting or rotating the arm

Frozen Shoulder Syndrome (Adhesive Capsulitis)What Are the Risk Factors?

Some factors can increase your odds of developing frozen shoulder:

  • Age:

People over the age of 40 are more likely to have frozen shoulder.

  • Inactivity:

People with prolonged inactivity or reduced shoulder mobility have a higher risk of developing frozen shoulder syndrome. Immobility may develop due to rotator cuff injury, broken arm, stroke, and post-operative processes. The most common causes are immobility after a shoulder injury, broken arm, or stroke. If the person has had a discomfort that makes it difficult to move the shoulder, he should consult a doctor for the exercises he can do to maintain the movement in the shoulder joints.

  • Systemic Diseases:

Diseases such as diabetes, hyperthyroidism, hypothyroidism, tuberculosis, Parkinson’s, cardiovascular diseases increase the risk of frozen shoulder syndrome.

What are the Stages of Frozen Shoulder Syndrome (Adhesive Capsulitis)?

Frozen shoulder syndrome can occur slowly and in 3 stages, and each stage can last for several months.

  1. Stage (Inflammation Stage):

Any movement of the shoulder can cause pain and limit the mobility of the shoulder. The condition gets progressively worse and may cause exacerbation of pain at night. This stage can last from 6 to 9 months.

  1. Stage (Freezing Stage):

At this stage, the sensation of pain may begin to subside. However, the shoulder becomes stiff. Therefore, it becomes more difficult to use the shoulder. Since it becomes difficult to move the shoulder, it becomes difficult for the patient to perform daily activities such as taking a shower and changing clothes.
This stage can last from 4 to 12 months.

  1. Stage (Dissolution Stage):

It is the stage where the mobility and range of the shoulder begin to improve. This stage can last from 6 months to 24 months.

Frozen Shoulder Syndrome (Adhesive Capsulitis) Diagnosis

  1. Clinical Findings

There is severe pain in the shoulder that radiates to the arm. It is accompanied by mild swelling and a burning sensation. The patient shows severe resistance to touching and moving the shoulder. Both passive and active joint movements have decreased in the shoulder joint.

  • Passive Range of Motion:

The range of joint that occurs when someone else moves your shoulder is called passive range of motion. Your doctor usually does.

  • Active Range of Motion:

The range you can do by yourself using your muscles is called active range of motion.

  • People with frozen shoulders have limited range of motion both actively and passively.
  1. Radiology Findings

  • X-ray:

All bone structures are clearly seen. However, there is no pathology directly related to frozen shoulder.

X-ray helps in the differential diagnosis of diseases that cause similar shoulder complaints such as shoulder calcific tendinitis and shoulder tumors.

  • Magnetic Resonance Imaging (MRI) and Ultrasound:

MRI shows soft tissues very well. It also provides detailed information about diseases such as rotator cuff tears, inflammation and calcification.

How Is Frozen Shoulder Syndrome (Adhesive Capsulitis) Treated?

Treatment for frozen shoulder syndrome usually involves controlling shoulder pain and maintaining as much range of motion in the shoulder as possible. In many cases of frozen shoulder syndrome, complete restoration of mobility is possible. However, this is a long process.

Frozen shoulder syndrome disease can usually heal on its own within 12 to 18 months, but it still helps patients get through this process more easily in the treatment of frozen shoulder syndrome.

What are the Methods Used in the Treatment of Frozen Shoulder Syndrome (Adhesive Capsulitis)?

  1. Medications:

Some medications that the doctor will recommend can help reduce the pain and inflammation associated with frozen shoulder syndrome.

  1. Therapy:

In the company of a physical therapist, range of motion exercises can be performed to increase mobility in the shoulder. Doing these exercises is very important for optimizing the recovery of mobility.

Surgical Methods and Other Procedures

  1. Injections:

With the help of some drugs injected into the shoulder, it is aimed to increase shoulder mobility and reduce pain.

  1. Shoulder Manipulation Under Anesthesia:

In this procedure, the patient does not feel pain due to the anesthesia. The doctor moves the shoulder joint in different directions to relieve the stretched tissue. However, arthroscopic surgery is rarely preferred due to the progression and the high risk of complications.

  1. Surgery:

Frozen shoulder syndrome surgery is rarely performed. If the treatments applied did not solve the problem, surgery is recommended.
In this surgical operation, the problem area is reached through small incisions made around the joint using arthroscopic surgical instruments. Rehabilitation should be done after surgery.
Physical therapy applications usually start the day after the surgery. The doctor explains the exercises to the patient. And the patient begins to practice the movements he needs to do. The main goal here is to completely restore the patient’s shoulder mobility.

What Happens If Frozen Shoulder (Adhesive Capsulitis) Is Not Treated?

After the symptoms of frozen shoulder begin, the duration of the disease can last from 2 years to 10 years, depending on the case. If the disease is not treated in cases with limited mobility, shoulder joint limitation may remain in the future life of the patients.

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