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What is Frozen Shoulder ?
If you have shoulder pain or stiffness or inability to move your shoulder as much as before, you may actually be suffering from this condition.
The humerus bone articulates with the shoulder blade bone. And this is surrounded by a tough connective tissue known as the capsule which is filled up with a lubricating fluid known as synovial fluid.
Frozen shoulder or adhesive capsulitis occurs when the capsule thickens and contracts after a period of inflammation or immobility with a reduction in the lubricating synovial fluid. This results then in pain and reduction in the range of motion of the shoulder joint.
We know that diabetic has a higher tendency to develop frozen shoulder, likely due to inflammation. The exact mechanism is still not clear.
2) Shoulder immobilisation
When the shoulder has been immobilised due to various reasons like fracture of the shoulder joint, rotator cuff tendinitis and when inadequate post fracture or post tendinitis physiotherapy and mobilisation has been done - there is a high tendency for frozen shoulder to occur.
Frozen shoulder usually occurs in adults age 40 -65. We rarely see this condition in young adults.
4) Other medical conditions
like thyroid disorders and Parkinson’s disease.
sometimes we don’t really know why it occurs. It happens.
- Pain and stiffness of the shoulder joint
- Reduction in the range of motion of the joint in all directions
- Fear of moving the shoulder joint due to pain resulting in a worsening in stiffness
The frozen shoulder develops typically in three stages
Patient feels the most pain and discomfort. As the pain worsens, the shoulder becomes more and more stiff with loss of range of motion.
the pain actually reduces in this stage but the stiffness remains and the loss of mobility
shoulder motion slowly improves due to the thawing of the capsule. Close to normal range of motion returns.
The period from the freezing stage to the thawing stage may take up to 2-3 years for recovery.
X-ray of the shoulder joint just to exclude any other bony issues such as
- osteoarthritis of the shoulder joint
- sometimes we may even uncover a fracture
In some cases, MRI may also be indicated if you suspect rotator cuff tears or ligamental impingement syndromes or even shoulder capsular tears.
1) Pain and anti-inflammatory medications
These medications can be given in the acute painful stage to reduce the pain and the inflammation so that the patient can resume early mobility to reduce the freezing and frozen stage.
2) Steroid shoulder joint injection
Steroids can be injected directly into the capsule to reduce the inflammation within the capsule and to stretch the capsule out using the fluid from the medications
However the mainstay of treatment would need to come from the patient themselves. By putting in effort into stretching and physical therapies. Here are some exercises, (please view video for instructions) : shoulder rotations, shoulder stretch, wall finger walk.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)