Understanding Frozen Shoulder and its Management

Introduction: The shoulder comprises two main joints: the larger glenohumeral joint, a ball-and-socket structure, and the smaller acromioclavicular (AC) joint, which forms between the clavicle and scapula. The shoulder joint is enveloped by a capsule that becomes a concern with a frozen shoulder. This condition leads to a thickened, swollen, and tight capsule, reducing joint space and causing pain and stiffness. The discomfort gradually worsens over time, with the condition lasting from one to three years.

Causes and Risk Factors: The precise cause of frozen shoulder remains uncertain, but it often affects women aged 40 to 60. Individuals with medical conditions like diabetes, stroke, thyroid disorders, Parkinson’s disease, and those who have undergone upper limb surgery or mastectomy are at higher risk. Roughly 10% to 20% of diabetic patients develop frozen shoulder.

Symptoms: Patients with frozen shoulder experience persistent pain and stiffness, making shoulder movement challenging or impossible. Dull or achy pain is usually felt in one shoulder, potentially radiating to the neck, arm, or shoulder muscles. Pain can intensify at night, disrupting sleep.

Diagnosis: Diagnosing a frozen shoulder primarily relies on history and examination. Tender shoulder and restricted passive motion, especially external rotation, are key indicators. While a physical exam suffices, imaging tests like X-rays, ultrasound, or MRI may be recommended to rule out other shoulder issues.

Conservative Treatment: Conservative approaches are often effective as initial treatment:

  1. Medications: NSAIDs alleviate pain and inflammation. If ineffective, your doctor may prescribe stronger pain relievers.
  2. Physiotherapy and Exercises: Strengthening and stretching exercises improve range of motion. Ultrasound and TENS therapy can also aid some patients.
  3. Rest and Ice: Rest during severe pain episodes and use ice to alleviate discomfort.
  4. Joint Injections: Corticosteroid injections can be considered to reduce pain and enhance range of motion.

Surgical Options: When conservative treatments fail, surgical interventions may be explored:

  1. Joint Distension: Sterile water injection stretches the capsule, facilitating better shoulder movement.
  2. Shoulder Manipulation: Surgeons gently stretch the capsule under general anesthesia.
  3. Arthroscopic Capsular Release: A minimally invasive procedure involving an arthroscope and surgical tools. The inflamed synovium covering the capsule is removed, and the thickened capsule is cut. This immediately improves the range of motion and reduces inflammation and pain. Subsequent physiotherapy is crucial to prevent further stiffness.

Conclusion: Understanding frozen shoulder and its management is crucial for a better quality of life. Dr. Sunil Choudhary, a specialist in orthopedic care, offers expertise in treating this condition. With a tailored approach encompassing both conservative and surgical methods, you can regain shoulder function and alleviate pain. Contact us for expert guidance and comprehensive care to restore your shoulder mobility and enhance your well-being.