Thawing the Mystery: Navigating the Multifaceted Challenge of Frozen Shoulder
Dec 15, 2023 -- Posted by :The condition that’s often referred to as frozen shoulder goes by many monikers: adhesive capsulitis, painful stiff shoulder, periarthritis, and idiopathic restriction of shoulder movement. Regardless of the name, frozen shoulder presents itself as a stiff, inflexible, and painful shoulder joint and it often arises in a mysterious way that’s sometimes difficult to trace. The etiology of frozen can be primary (typically, no known cause) or secondary to other conditions. Because of its often nebulous onset, there is great debate in the scientific literature regarding how to best manage the condition.
Frozen shoulder impacts up to 5% of the global population, primarily affecting individuals aged between 40 and 60 years, with a higher prevalence of 10% to 38% among those with diabetes or thyroid diseases. Beyond diabetes and thyroid issues, additional factors contributing to the risk of frozen shoulder encompass Dupuytren’s syndrome, kidney stones, cancer, Parkinson’s disease, shoulder injury, smoking, post-stroke, heart and neck surgery, and chronic regional pain syndrome. It's noteworthy that a substantial 85% of frozen shoulder patients possess at least two risk factors, while nearly 40% have a minimum of three.
Characterized as an inflammatory condition, frozen shoulder induces fibrosis in the glenohumeral ball and socket joint capsule, resulting in a gradual and progressive stiffness with a significant loss of motion, particularly in external rotation. In the initial stages, distinguishing frozen shoulder from other shoulder pathologies can pose challenges, but the differentiation becomes more straightforward as the condition progresses. Contrary to a common misconception among healthcare professionals, frozen shoulder doesn't necessarily resolve spontaneously in most patients; untreated, it can persist for years.
Typically, the initial approach for frozen shoulder involves physical treatments, combining manual therapies, physical therapy, and personalized home exercises. While medical doctors may offer temporary relief through steroid injections or prescribed medications, these interventions have limited impact on the accumulation of fibrotic collagenous scar tissue, often leading to symptom recurrence. When conservative measures prove ineffective, surgical interventions such as open or arthroscopic capsular release and hydrodilation may be suggested to enhance shoulder range of motion and alleviate pain. However, it's important to note that these procedures carry the potential for complications.
As with many musculoskeletal conditions, frozen shoulder is easiest to manage in its earliest stages. Because of the nature of frozen shoulder, co-management to address comorbidities with the patient’s medical doctor may be necessary to achieve the best possible outcome in the shortest time.
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https://pubmed.ncbi.nlm.nih.gov/22742964/
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