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Frozen shoulder (adhesive capsulitis) facts
- Frozen shoulder is the result of scarring, thickening, and shrinkage of the joint capsule.
- Any injury to the shoulder can lead to adhesive capsulitis.
- Frozen shoulder symptoms and signs include loss of range of shoulder movement, stiffness, and pain.
- A frozen shoulder is usually diagnosed during an examination.
- A frozen shoulder usually requires aggressive treatment.
What is a frozen shoulder?
A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion but also when the doctor attempts to move the joint fully while the patient relaxes. A frozen shoulder is medically referred to as adhesive capsulitis.
What causes a frozen shoulder?
Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Any shoulder injury can lead to a frozen shoulder, including tendinitis, bursitis, and rotator cuff injury (rotator cuff syndrome). Adhesive capsulitis occurs more frequently in patients with risk factors of diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder.
What are symptoms and signs of a frozen shoulder?
Symptoms and signs of a frozen shoulder include shoulder pain, stiffness, and loss of range of shoulder motion. The shoulder range of motion is limited when either the patient or an examiner attempts to move the joint. The shoulder can develop increased pain with use. These symptoms can make sleep very uncomfortable.
How do health care professionals diagnose a frozen shoulder?
A frozen shoulder is suggested during examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement. Underlying diseases involving the shoulder can be diagnosed with the history, examination, blood testing, and X-ray examination of the shoulder.
If necessary, the diagnosis can be confirmed when an X-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is called arthrography. The tissues of the shoulder can also be evaluated with an MRI scan.
What conditions can mimic adhesive capsulitis?
Inflammation of the shoulder joint (arthritis) or the muscles around the shoulder and degenerative arthritis of the shoulder joint can cause swelling, pain, or stiffness of the joint that can mimic the range of motion limitation of a frozen shoulder.
Injury to individual tendons around the shoulder (tendons of the rotator cuff) can limit shoulder-joint range of motion but usually not in all directions. Often during the examination of a shoulder with tendon injury (tendinitis or tendon tear), the doctor is able to move the joint with the patient relaxed beyond the range that the patient can on their own.
What is the treatment for a frozen shoulder?
The treatment of a frozen shoulder usually requires an aggressive combination of over-the-counter non-steroidal anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy (physiotherapy). Without aggressive treatment, adhesive capsulitis can be permanent.
Diligent physical therapy is often essential for recovery. A physical therapist will administer ultrasound, electric stimulation, range-of-motion exercise maneuvers, stretching, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.
It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.
Sometimes a frozen shoulders is resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.
What is the prognosis of a frozen shoulder?
The prognosis of a frozen shoulder depends on its response to physical therapy, exercises, and treatments as described above. Again, it is essential to avoid reinjuring the shoulder tissues during the rehabilitation period. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. Without aggressive treatment, a frozen shoulder can be permanent.
Is it possible to prevent a frozen shoulder?
Prevention of a frozen shoulder involves avoiding injury or reinjury to the shoulder.
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Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Lee, Kyu Hong, et al. "Adhesive Capsulitis of the Shoulder Joint: Value of Glenohumeral Distance on Magnetic Resonance Arthrography."? Journal of Computer Assisted Tomography 41.1 January 2017: 116-120.
Neviaser, A.S., and R.J. Neviaser. "Adhesive capsulitis of the shoulder." J American Academy Orthop Surg 19.9 Sept. 2011: 536-542.
Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.
Zreik, Nasri Hani, et al. "Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence." Muscles Ligaments Tendons J 6.1 Jan.-Mar. 2016: 26-34.
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BursitisBursitis is inflammation of a bursa. A bursa is a fluid-filled sac found in the joints that cushions them. Bursitis is an inflammation of the bursa, most commonly caused by repetitive motion. Bursitis can be caused by a bacterial infection and should be treated with antibiotics, ice, and rest.
Allergy (Allergies)An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Arthritis (Joint Inflammation)Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout.
ArthroscopyDuring arthroscopy, a tube-like viewing instrument (called an arthroscope) is used to examine the internal structure of a joint for diagnosis or treatment. Arthroscopy is useful when attempting to diagnose or treat various types of arthritis and joint injuries. This surgical procedure may often be performed in an outpatient setting.
Broken BoneA broken bone is a fracture. There are different types of fractures, such as:
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Symptoms of a broken bone include pain at the site of injury, swelling, and bruising around the area of injury. Treatment of a fracture depends on the type and location of the injury.
Cortisone InjectionCortisone injections are used to treat small areas of inflammation or widespread inflammation throughout the body. There is minimal pain from these injections, and relief from the pain of inflammation occurs rapidly.
CT Scan vs. MRI
CT scan (computerized tomography) is a procedure that uses X-rays to scan and take images of cross-sections of parts of the body. CT scan can help diagnose broken bones, tumors or lesions in areas of the body, blood clots in the brain, legs, and lung, and lung infections or diseases like pneumonia or emphysema.
MRI (magnetic resonance imaging) is a procedure that uses strong magnetic fields and radiofrequency energy to make images of parts of the body, particularly, the organs and soft tissues like tendons and cartilage.
Both CT and MRI are painless, however, MRI can be more bothersome to some individuals who are claustrophobic, or suffer from anxiety or panic disorders due to the enclosed space and noise, the machine makes.
MRI costs more than CT, while CT is a quicker and more comfortable test for the patient.
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MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Frozen ShoulderIt's got nothing to do with cold weather. It means your shoulder is jammed up. WebMD guides you through the causes of frozen shoulder and what you can do about it.
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
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- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
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