Frozen shoulder most commonly affects people between the ages of 40- 60, and occurs in women more often than men (2:1). The cause of frozen shoulder is not known and patients usually present with pain and shoulder stiffness. Initial treatment is usually non-surgical, with a period of rest followed by guided physiotherapy. Thankfully, after a period of worsening symptoms, the frozen shoulder tends to spontaneously improve; however full recovery may take 1-2 years. In a small number of cases surgery may be required to expedite recovery, relieve pain and/or treat other coexisting conditions (such as a traumatic supraspinatus tendon tear).
Frozen shoulder (also referred to as adhesive capsulitis) presents with pain and stiffness in the shoulder; often without any trauma or incident.
In a frozen shoulder, the shoulder capsule thickens and becomes stiff and tight. The thick bands of tissue (adhesions) develop within the shoulder joint limiting movement.
The classical presentation of frozen shoulder is initially intense pain and then progressively being unable to move your arm. Often there is no history of trauma or any other illness.
The causes of frozen shoulder are not fully known; there is no clear connection to arm dominance or occupation. There are a few risk factors, however, that put you at increased risk of a frozen shoulder.
Frozen shoulder commonly occurs in those aged between 40 and 60, and occurs in women more often than men. In addition, people with diabetes and thyroid disorders are at an increased risk of a frozen shoulder. There are three phases of a frozen shoulder: painful, stiff and thawing out. Each phase case lasts 2-3 months.
It is important to correctly diagnose frozen shoulder and exclude any other pathology: such as rotator cuff tears or shoulder joint arthritis. For this reason, younger patients may benefit from an MRI scan. However, most of the diagnosis is made on history and clinical examination.
The natural history of a frozen shoulder is good and patients generally improve over time. Some patients may benefit from a cortisone injection into the joint. Physiotherapy is a useful addition once the shoulder starts to thaw out. Occasionally, surgery is needed to free up the capsule to allow better range of movement.
Frozen shoulder surgery is reserved for patients whose range of motion is going backwards at 6-9 months into a frozen shoulder. It is also suitable for those who are found to have a time urgent issue on the MRI scan (such as an acute rotator cuff tear or biceps tendon dislocation).
With careful patient selection the results after capsular release for frozen shoulder are good to excellent. It is vital that immediate physiotherapy commences post-surgery to prevent scarring of the released capsule.
This gentleman in his 60s suffered from a frozen shoulder for almost a year; his symptoms were unrelenting and he failed to improve over time despite non-surgical treatment. Examination and MRI imaging confirmed ongoing frozen shoulder as well as biceps tendonitis, subacromial bursitis, and AC joint arthritis; thankfully his rotator cuff was intact.
He underwent arthroscopic frozen shoulder surgery (capsular release) and a biceps tenodesis, subacromial decompression and excision of his AC joint. Range of motion exercises were commenced immediately after surgery using the JPL protocol.
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