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What is it?
Frozen shoulder (also known as adhesive caspuslitis or contracted capsule) is a condition which gives rise to relentless and severe pain with significant stiffness. The exact cause for the onset of this condition is not fully understood. Although it can start for no obvious reasons, sometimes it can occur after trauma or immobilisation of the arm, general illness like following heart-attack.
This affects the joint liner, capsule and the ligaments but generally the tendons and joint cartilage are not affected. The structures affected become thick and inflamed and can completely encase the tendons with ‘scar’ tissue. With time these contract and thus results in severe stiffness. The inflamed structures, like the tissues that grow in a healing wound, have new blood vessels, sensitive nerve endings and cells that produce scar tissues.
There is recoganised association of frozen shoulder and diabetes, Dupuytren’s contracture, thyroid problems, epilepsy or high cholesterol. It is said to go through 3 phases; but in practice it may be difficult to distinguish these stages. It tends to ‘resolve’ in about 2 years.
Pain is typically felt around the shoulder but more so around the upper arm around the insertion of the deltoid or along the biceps muscle. Stretch and jerk relate exacerbation of the pain is very typical. The
pain can be extremely disabling. It affects all activities of daily living and sleep. Some may also develop intermittent pins & needle sensation in the fingers. Pain killers do not usually help much. Holding the arm slightly away from the body with elbow bent and a support can give some pain relief. Despite the severe pain most patients carry on with normal day to day activities.
In the majority of cases, simple measures like supporting arm and positioning appropriately can help. Avoiding activities where there could be rapid stretching of arm, rest and a course of anti-inflammatory tablets may help. Well-directed physiotherapy may also give good pain relief; but in the initial stages, it is likely to exacerbate the pain. However, physiotherapy is the core-stone in the treatment. In some instances, one may need injection of cortisone (steroid) and local anaesthetic mixture into the joint to settle the inflammation. This may be occasionally repeated. Improvement is usually gradual and may take place over many weeks or even months.
Overall, a third get better with activity modification, tablets and physiotherapy and a third get better with injections. Those who do not get better may require surgical intervention especially when the quality of life is affected. This may be in form of manipulation under anaesthesia or arthroscopic frozen shoulder release.