| 
Frozen shoulder, or adhesive capsulitis, is a condition characterized
by a loss of motion in the shoulder joint.
The diagnosis is often used for any painful shoulder condition associated
with a loss of motion, but it is important to understand what caused
the symptoms in order for treatment to proceed effectively. Often people
experience trauma to the shoulder prior to the onset of the frozen shoulder,
and sometimes there is no known cause for the symptoms.
The shoulder joint is a ball and socket joint. The ball is the end of
the arm bone, humeral head, and the socket is the glenoid. Together
they form the glenohumeral joint. In the normal state, this joint has
more range of motion than any other joint in the body. With frozen shoulder,
however, the limits in motion can make this a functionally useless joint.
The condition of frozen shoulder is characterized by a decrease in motion,
primarily lifting the arm and turning it inwards. The condition is most
common in the 40-60 year old age group and it is twice as common in
women as men. People usually experience pain as the first symptom, followed
by the loss of motion and a decrease in pain. Normally a gradual return
of motion will follow; however, the length of time for recovery can
be prolonged, with an average duration of 18 months.
The treatment primarily consists of pain relief and physical therapy.
Exercise serves two functions. First, to increase the motion in the
joint. Second, to minimize the loss of muscle mass on the affected arm
due to decreased activity. Therapists may also incorporate ultrasound,
ice, heat, and other modalities into the rehabilitation program.
Cortisone injections are also commonly used to decrease the inflammation
in the joint. Usually up to three injections can be given, spanning
several weeks. After three injections, if improvement is not seen it
is unlikely that more injections will alter the course of this condition.
If the above treatments do not resolve the problem, occasionally a patient
will need to go to the operating room. If this is the case, the doctor
may perform a manipulation under anesthesia. Simply put, the patient
gets a whiff of gas (or other anesthesia) and the doctor moves the arm
to break up adhesions; there is no actual surgery involved. Alternatively,
an arthroscope can be inserted into the joint to cut through adhesions.
Surgical release is rarely a necessary technique.
|