“If this blog helped you out, don’t keep it to yourself—share the link on your socials!” 👍 “Like what you read? Spread the love and share this blog on your social media.” 👍 “Found this useful? Hit share and let your friends know too!” 👍 “If you enjoyed this post, please share the URL with your friends online.” 👍 “Sharing is caring—drop this link on your social media if it helped you.”

Tuesday, August 12, 2025

Frozen shoulder


Definition

Frozen shoulder, medically known as adhesive capsulitis, is a chronic inflammatory and fibrotic condition of the glenohumeral joint capsule resulting in progressive stiffness, pain, and significant restriction of both active and passive shoulder movements. It is a self-limiting condition but can persist for months to years.

Epidemiology

  • Prevalence: approximately 2–5% in the general population

  • Peak incidence: between 40–60 years of age

  • More common in women

  • Higher risk in individuals with systemic conditions such as diabetes mellitus, thyroid disease, and cardiovascular disease

Etiology

Primary (idiopathic) adhesive capsulitis

  • No clear precipitating cause; often insidious onset

  • Thought to involve chronic low-grade inflammation and fibrosis

Secondary adhesive capsulitis

  • Post-traumatic: after shoulder fracture, dislocation, or soft tissue injury

  • Post-surgical: following rotator cuff repair, mastectomy, or other upper limb surgeries

  • Associated with systemic diseases:

    • Diabetes mellitus (type 1 or type 2)

    • Hypothyroidism or hyperthyroidism

    • Cardiovascular disease

    • Parkinson’s disease

Pathophysiology

  • Inflammatory process involving the synovium and joint capsule

  • Fibroblastic proliferation and thickening of the capsule

  • Contraction of the capsule and loss of the axillary recess

  • Adhesions form between the capsule and humeral head, limiting motion

Clinical Presentation

Symptoms:

  • Gradual onset shoulder pain, often poorly localised

  • Pain aggravated by movement and at night (disturbs sleep)

  • Progressive stiffness and limitation of both active and passive range of motion

  • Difficulty with overhead activities and behind-the-back movements

Signs:

  • Global restriction in range of motion, especially external rotation

  • Tenderness around the deltoid and bicipital groove

  • No signs of arthritis on radiographs (normal joint space)

Natural History – Three Stages

  1. Freezing (painful) stage – 2–9 months

    • Progressive pain, especially at night

    • Increasing stiffness

  2. Frozen (stiff) stage – 4–12 months

    • Pain gradually decreases

    • Marked stiffness persists

    • Daily activities significantly affected

  3. Thawing (resolution) stage – 6–24 months

    • Gradual improvement in range of motion

    • Pain minimal or absent

Diagnosis

Clinical diagnosis based on history and examination:

  • Restriction of both active and passive range of motion

  • Normal X-ray or MRI (to rule out other causes)

Imaging:

  • X-ray: usually normal (may exclude arthritis or calcific tendinitis)

  • MRI: thickening of coracohumeral ligament, capsule, and rotator interval; decreased axillary pouch volume

Management

Treatment aims to relieve pain, restore movement, and shorten disease duration.

1. Patient Education

  • Explanation of natural history and self-limiting nature

  • Importance of physiotherapy and compliance with home exercise programs

2. Analgesia and Anti-inflammatory Medication

  • Paracetamol: 500–1000 mg orally every 4–6 hours as needed (max 4 g/day)

  • NSAIDs (if no contraindications):

    • Ibuprofen 400–600 mg orally every 8 hours

    • Diclofenac 50 mg orally 2–3 times daily

    • Naproxen 500 mg orally twice daily

  • Topical NSAIDs: diclofenac gel applied to the shoulder up to 3–4 times daily

3. Intra-articular Corticosteroid Injections

Most effective in the early freezing stage for pain relief.

  • Triamcinolone acetonide 20–40 mg intra-articularly, single injection (may repeat after 6 weeks if needed)

  • Methylprednisolone acetate 40 mg intra-articularly as alternative

  • Always combined with physiotherapy for best outcomes

4. Physiotherapy

Essential throughout all stages:

  • Passive and active-assisted range of motion exercises

  • Pendulum exercises

  • Capsular stretching and mobilisation

  • Gradual strengthening as mobility returns

  • Home exercise program 2–3 times daily

5. Oral Corticosteroids (Short Course)

For severe early pain and inflammation when injections are not suitable:

  • Prednisolone 15–30 mg orally once daily for 2–3 weeks, taper gradually

6. Other Interventions

  • Hydrodilatation (distension arthrography): injection of saline + steroid into the joint capsule under imaging guidance to stretch the capsule

  • Manipulation under anaesthesia (MUA): reserved for refractory cases; performed under general anaesthesia

  • Arthroscopic capsular release: surgical option for persistent severe restriction after >6 months of conservative therapy

Prognosis

  • Most patients recover within 12–36 months, though mild stiffness may persist in some cases

  • Early intervention with corticosteroid injections and physiotherapy can shorten the course

  • Higher recurrence and prolonged disease in diabetics




on

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)