Introduction
Adhesive Capsulitis or Frozen Shoulder is a disorder characterized by pain and significant loss of the full range of motion. The process involves inflammation, scarring, thickening and contracture of the capsule surrounding the shoulder joint.
Physicians point out that though many muscles can be involved in the condition of frozen shoulder, the subscapularis muscle is often seen as the main problem area.
The condition is more common in individuals above the age of 50 as well as in women between the ages of 40 to 70 years old.
Frozen Shoulder – Stages
An episode of a frozen shoulder is normally progressive .i.e. it worsens with time or may even improve spontaneously. The main symptom is a pain located around the shoulder joint along with restricted motion. The condition normally passes through the following stages in most of the patients:
Stage I – Painful/Freezing Stage:
This is often the most painful stage. Motion is severely restricted and the stage lasts for 6-12 weeks on a whole.
Stage II – Frozen Stage:
The pain normally eases up, but the stiffness worsens. The frozen stage can last from 4-6 months in all.
Stage III – Thawing Stage:
This is a very gradual stage and motion steadily improves over a lengthy period of time. The thawing stage can extend up to more than a year.
Treatment Modalities
The treatment plan for frozen shoulder is normally based on two important goals- pain relief and rehabilitation.
Success of the treatment for a frozen shoulder generally depends on the time period when the patients reports about the condition. For instance, patients who approach their health care provider in Stage II (Frozen Stage) are often quite difficult to treat. The treatment options for a frozen shoulder are typically categorised in to two types. Here we discuss each of them briefly:
A) Non-surgical options:
These focus on pain relief and function restoration of the shoulder. Measures include:
· Medication
· Physical therapy, for exercises to stretch muscles and restore motion and function to the shoulder.
· Heat and ice therapies to reduce pain and swelling
· Suprascapular nerve blocks
· Intraarticular corticosteroid injections
B) Surgical options:
These are resorted to if more conservative measures have failed over months and include:
· Closed manipulation, involving forceful movement of the arm at the shoulder joint.
· Arthroscopic surgery, in order to improve movement at the joint. Performed under anesthesia, this is followed by an intensive physical therapy programme to mobilize the shoulder joint.
- British Medical Journal (BMJ) article on the use of Suprascapular Nerve Blocks
