Literally, the answer to the questions of “What is the main cause of frozen shoulder?” is “Unknown”! Though it seems strange it is true that the cause of frozen shoulder is not well known.
Frozen shoulder is also known as adhesive capsulitis. ‘Frozen shoulder may be a clinical syndrome characterized by gross restriction of shoulder movements and which is related to contraction and thickening of the joint capsule.
It’s a condition that affects the middle-aged, in whose shoulder cuffs degenerative changes are occurring. Restriction of movements is usually severe, with virtually no glenohumeral movements possible, but within the milder cases rotation, especially internal rotation, is primarily affected.
The condition is especially related to diabetes, Dupuytren’s disease, hyperlipidemia, hyperthyroidism, cardiac disease, and hemiplegia. After recovery from neurosurgery, it occasionally appears. The researchers found that Signs and symptoms typically begin gradually, worsen over time and normally it resolves spontaneously after about 18 months.
Treatment for frozen shoulder may be range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. During a very small percentage of cases, arthroscopic surgery could also be needed to loosen the joint capsule in order that it can move more freely. Before going to the question’s answer of “What is the main cause of frozen shoulder?”, we will know about the symptoms of frozen shoulder.
Symptoms of frozen shoulder
The patient, aged 40–60, may provide a history of trauma, often inconsiderable, followed by aching within the arm and shoulder. The pain gradually increases in severity and sometimes prevents sleeping on the affected side.
After several months it begins to vanish, but stiffness becomes an increasing problem and continuing for an additional 6–12 months after pain has disappeared. Gradually movement is regained, but it’s going to not return to normal and a few pain may persist.
Aside from slight wasting, the shoulder looks quite normal; tenderness is occasionally marked. The cardinal feature may be an obstinate lack of active and passive movement altogether directions.
Shoulder exercises for frozen shoulder to get relief from pain
Stages of frozen shoulder
The frozen shoulder doesn’t occur overnight. In fact, there’s a somewhat long process that develops within the shoulder once the condition originates. Experts have separated this progresses through three overlapping clinical phases.
- Acute/ painful/ freezing phase: In this phase, the shoulder becomes stiff and is very painful to move. The pain gradually increases and it may worsen at night. The range of motion of the shoulder started to limited and the inability to move the shoulder increases. This stage lasts 2 to 9 months.
- Frozen/ Adhesive/ stiffening phase: Pain starts to diminish, progressive loss of shoulder movement may happen. Pain may feel only at extremes of movement. This phase may occur at around four months and last for about twelve months.
- Thawing / Resolution phase: In this stage, pain minimizes, and the skill to maneuver the shoulder slowly improves. Spontaneous, progressive improvement in functional range of motion may last anywhere from 5 to 24 months.
Despite this, some studies suggest that it is a self-limiting condition, and should last up to 3 years. Though other studies have shown that up to 40% of patients may have persistent symptoms and restriction of movement beyond three years.
It’s estimated that 15% may have persistent pain and future disability. Effective treatments which shorten the duration of the symptoms and disability will have a big value on reducing morbidity.
From the outset, we knew that the main cause of the frozen shoulder is unknown. But there have some possible and pathological causes of frozen shoulder. And should remember that these causes are not exact.
The process may begin with an injury (such as a fracture) or inflammation of the soft tissues, typically due to overuse injuries like bursitis or tendinitis of the structure. Inflammation causes pain that’s worse with movement and limits the shoulder’s range of motion.
When the shoulder becomes immobilized in this way, the connective tissue called the joint capsule is surrounded by the glenohumeral joint is thickened and contract.
Normally the joint capsule has folds that will expand and contract because the arm moves into various positions. During a frozen shoulder, the capsule has become inflamed and scarring develops.
The scar formations are called adhesions. Because the capsule’s folds become scarred and tightened, shoulder movement becomes restricted and it becomes painful when moving the joint. This condition is named adhesive (scarring) capsulitis (inflammation of the capsule).
Risk factors of frozen shoulder
- Age between 40-60 years old
- Women’s are more affected than man
- Rotator cuff injury
- Broken arm
- Recovery from surgery
- Diabetes mellitus
- Dupuytren disease
- Thyroid disorder
- Avascular necrosis
- Metastatic disease
- History of cancer
- Fever, chills, severe (inexplicable) pain
- Complex regional pain syndrome
Diagnosis of frozen shoulder
Underlying diseases involving the shoulder are often diagnosed with the history, examination, blood testing, and X-ray examination of the shoulder.
Not every stiff or painful shoulder maybe a frozen shoulder, and indeed there’s some controversy over the standards for diagnosing ‘frozen shoulder’. Stiffness occurs during a sort of condition – arthritic, rheumatic, post-traumatic, and postoperative.
There are two features to diagnose frozen shoulder-
(1) Painful restriction of movement within the presence of normal x-rays; and
(2) A natural progression through three successive phases.
When the patient is first seen, variety of conditions should be excluded:
Infection In patients with diabetes, it’s particularly important to exclude infection. During the primary day or two, signs of inflammation could also be absent.
Post-traumatic stiffness after any severe shoulder injury, stiffness may persist for a few months. It maximal at the beginning and gradually diminishes, unlike the pattern of a frozen shoulder.
Diffuse stiffness if the arm is nursed over over-mindfully (for example lower arm break) the shoulder may stiffen. Again, the frozen shoulders characteristic pattern is absent.
Reflex sympathetic dystrophy Shoulder pain and stiffness may follow myocardial infarct or a stroke. The highlights are practically similar to those of a frozen shoulder and it’s been recommended that the latter may be such reflex sympathetic dystrophy. The entire upper limb is involved in severe cases, with trophic and vasomotor changes within the hand (the ‘shoulder–hand syndrome’).
If necessary, the diagnosis is often confirmed when an X-ray contrast dye is injected into the shoulder to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is named arthrography. The tissues of the shoulder also can be evaluated with an MRI scan.
Scratch test for frozen shoulder
If a patient has limitations in hand elevation, then apply a scratch test for the diagnosis of a frozen shoulder. In the scratch test, the patient is asked to place his/her arm above the head and reach behind the neckline to touch his/her upper back. Scratch test analyzes the rotation of upward, external, and elevation.
During the physical examination, if the patient has severe pain, then the physical assessment is marked positive. Previous researches showed that the range of motion and scratch test is good for diagnosing frozen shoulder. Typically physiotherapists use this test to detect frozen shoulders.
Treatment of Frozen shoulder
Frozen shoulder generally gets better over time, although it’s going to take up to three years. The 2 main goals of treatment are to extend motion and to decrease pain. In time and with treatment, patients experience relief pain Out of 9 of 10. The treatment includes for frozen shoulder is-
Hot and cold compression packs: These help to reduce pain and swelling. These can be buy-from-here
Painkillers: Not all painkillers are suitable for each patient, so it’s important to consult with a doctor before taking any quiet painkillers.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce inflammation and decrease mild pain. Pain killers like ibuprofen, are available to get from any registered medical shop or Purchase-from-here
Acetaminophen (paracetamol, Tylenol) is suggested for extended use and is additionally available to get-online
Prescription painkillers, like codeine, an opiate-based painkiller, may reduce pain.
Steroid injections: Cortisone may be a powerful anti-inflammatory medicine that’s injected directly into a patient’s shoulder.
Hydro dilatation: If the symptoms of the patients aren’t relieved by other nonsurgical methods, the doctor may recommend hydro dilatation. This procedure involves gently injecting an outsized volume of sterile fluid into the shoulder to expand and stretch the shoulder capsule. Hydro dilatation is conducted by a radiologist who uses imaging to guide the location of fluid.
Transcutaneous electrical nerve stimulation (TENS): To control pain TENS is used, which works by numbing the nerve endings within the spinal cord. The TENS machine is applied to the skin on the affected shoulder which sends small electrodes, or small electric pads. Various TENS machines from different brands are available to Tens-machine
Physiotherapy: Physiotherapy can assist you to get movement back in your shoulder.
A physiotherapist will decide the number of sessions you would like. The exact number relies upon how your shoulder reacts to treatment.
The physiotherapist will first check what proportion movement you’ve got in your shoulders.
Treatments from a physiotherapist include:
1. Strengthening exercises
2. Stretching exercises
3. Good posture advice
4. Pain relief advice
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