Frozen Shoulder is a condition where the shoulder does not move normally. This disorder of the joint capsule is also known as Adhesive Capsulitis. In this condition, the patient will be unable to move the arm up or turn it to the side (loss of external rotation of the shoulder). This condition is painful and x-rays are usually normal.
It occurs due to thickening and tightening of the shoulder capsule and ligaments, especially the coracohumeral ligament. Frozen shoulder can occur by itself or following trauma, even from minor trauma, and it can follow surgery. The process of frozen shoulder usually begins with pain. The pain is severe, especially with movement, and the patient is usually unable to sleep. The patient will be unable to move the shoulder from the pain, and the condition will lead to stiffness of the shoulder.
It may take a long time to resolve, perhaps even several years. The condition of frozen shoulder occurs more in diabetics, especially those who are insulin dependent, and the condition is more severe in diabetics. This condition also occurs in patients with Dupuytren’s Contracture and hypothyroidism. Frozen shoulder tends to occur more in females, especially in their fourth decade of life.
During the physical examination, the physician will need to examine the patient’s range of motion both actively and passively.
It is important to differentiate the shoulder movement from scapulothoracic movement. The physician will need to examine the other shoulder as well. The risk is high for the other shoulder to also become frozen. Exclude dislocation of the shoulder, especially posterior dislocation. With posterior dislocation, the patient will have limited external rotation, the same as adhesive capsulitis. The physician will need to obtain an axillary view x-ray to differentiate between the two conditions. Not every frozen shoulder is adhesive capsulitis. It is important to exclude dislocation, diabetes, infection, fractures, and tumors.
Treatment is usually complex which consists of pain control and early aggressive uninterrupted continuous physiotherapy, as well as shoulder manipulation and injections. Surgery is sometimes necessary in order to release the contractures.
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