Frozen shoulder 4.19/5 (16)

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Definition

Frozen shoulder (frozen shoulder, adhesive capsulite) is a painful but not dangerous rheumatic inflammation of the shoulder. The inflammation leads to increased connective tissue (fibrosis) and stiffness around the shoulder joint

Occurrence

Adhesive capsule, frozen shoulder
"Frozen shoulder". illustration: CDC [Public domain], via Wikimedia Commons

About 3-5% of the population is attacked. Women make up 70% of cases and the age group 40-60 years is most at risk. In diabetes mellitus (both type I and type II) up to 20% get frozen shoulder. If you have had a frozen shoulder on one side, the possibility of similar on the other side increases (Kingston K, 2018).

Disease Cause

The disease often begins as tendonitis after an overload or for an unknown reason. Risk factors are other diseases. Diabetes mellitus (both type I and type II) is predisposing. Other dispositions are systemic connective tissue disease, metabolic disease, Dupuytren's contracture (in the palm of the hand), blows and injuries. If you have had a frozen shoulder on one side, the possibility of a similar one on the other side increases

Symptoms

The course of the disease can be divided into three stages

  1. Pain. Frozen shoulder begins with severe shoulder pain both day and night. This first stage lasts from a few weeks to months.
  2. "Frozen" phase. Rheumatic inflammation of the tendons and other connective tissue that surrounds the joint (joint capsule) causes thickening (fibrosis) and reduced mobility, so that the shoulder joint gradually stiffens completely or partially. At this stage the joint stiffens and it becomes impossible to lift the arm or move the hand behind the back (reduced elevation and rotation)
  3. "Thawing". Movement gradually improves in stage three. Full mobility is often seen after a total of 1-2 years from the onset of the disease.

Examinations

Medical history with typical symptoms (see above) gives suspicion of frozen shoulder.

Upon examination It is demonstrated (by testing passive movement in the joint) that the shoulder joint itself has become more or less stiff (reduced abduction and rotation) even when all muscles are relaxed.

Laboratory tests expected to be normal. To assess possible underlying disease, fasting blood sugar and metabolic tests (TSH, free-T4) are relevant. CRP and hypotension (SR) are expected to be normal, corresponding to rheumatoid factors and anti-CCP.

Imaging. MRI examination or assessment with ultrasound can confirm the diagnosis. Thickened joint capsule and narrow conditions in the shoulder joint are detected. On ultrasound examination, one can sometimes observe reduced mobility of the supraspinatus tendon in the joint.

Diagnosis usually exhibited on the basis of medical history and clinical examination.

Similar conditions, differential diagnoses

Disc slippage in the neck (cervical disc prolapse), fracture damage, calcareous tendinitis, cancer, rotator cuff impingement, Polymyalgia rheumatica, shoulder impingement syndrome (St Angelo JM, 2021)

Treatment

For pain, tablets such as paracetamol (Paracet, Pinex) or NSAIDs (ibuprofen, naproxen, diclofenac, etc.) are used. At an early stage (stage one), injection with cortisone may also be useful.

Against stiffness, it is recommended in gentle movements, such as letting the arm swing freely. Physiotherapists are often contacted to adapt this treatment. Surgery (arthroscopic capsule solution) or attempts to loosen the stiffness by force are rarely beneficial.

Prognosis

Frozen shoulder does not attack other parts of the body, and in the long run the prognosis is good, although some will have persistently reduced mobility. After two to three years, approximately 90% will have regained almost normal mobility and are without particular pain.

Literature


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