WHAT IS FROZEN SHOULDER SYNDROME?

Frozen shoulder (also known as adhesive capsulitis), also it is understandable from its name, is a disease in which shoulder movements are severely restricted and pain is accompanied. The frozen shoulder occurs after thickening and harden of the soft tissues surrounding the joint, especially the joint capsule. These thick and shortened tissues prevent shoulder movements.

What are the Symptoms of Frozen Shoulder?

Usually, a single shoulder become stiff, but in one third of patients, the stiffness may occur as bilateral. Limitation of movement is an early sign of frozen shoulder. If you have difficulty moving your hand over your head, to other shoulder and your back, your shoulder movements are restricted. Movement is restricted in all directions. The patient cannot comb its hair or touch its back. There is also increased shoulder and arm pain, especially at night.

The development of the frozen shoulder is slow, developing process, it develops in 3 stages and over a long period of time:

●In the first phase (early period, inflammation phase):

As the pain gradually increases, movements begin to be restricted in all directions. This circuit lasts about 1-3 months.

●Second phase (adhesion period, freezing phase):

During this period, the pain gradually decreases, but limitation of movement is evident. The movements were reduced by 50% compared to the opposite arm. This period ends in 4-6 months.

●Third phase (Decomposition phase):

Pain decreases rather well and shoulder movements slowly return. The situation begins to be normal. However, the patient cannot move his shoulder at all.  At the end of the second year, most symptoms of the disease subsided, but about one of fifth of patients still have uncomfortable pain and limitation of movement. Shoulder movements are partially improved after this period. If it is treated well, the range of motion of the shoulder is almost restored. Some patients may require surgery to provide shoulder motion.

How to diagnose Frozen Shoulder?

The diagnosis of frozen shoulder is made by examination. It is seen by the physician, that shoulder movements are limited both actively and passively MRI may be requested not to diagnose frozen shoulder but to distinguish other problems.

How is Frozen Shoulder Treated ?

The primary treatment of frozen shoulder is non-surgical methods. Treatment is based on relieving pain and restoring movements. Anti-inflammatory pain medications and intra-articular cortisone injections, stretching and cold applications in the first phase which will not increase the pain are used for this purpose. After the freezing phase and when the pain subsides, more challenging exercises can be started. Again, to relieve pain; nerve blocks, radiofrequency and burning the pain sensation receiving nerve can give good results.

In patients who have not responded to non-surgical treatments for six months, manipulation under general anaesthesia may be performed. After full muscle relaxation during manipulation, the doctor loosens the capsule with various manoeuvres and opens shoulder movements. After a serious rehabilitation program, shoulder movements which re-obtained are preserved.

If the shoulder movements cannot be achieved by manipulation, the soft tissues that are thickened and which prevent movements are loosened by cutting in arthroscopic surgery. Rehabilitation should be performed after frozen shoulder surgery. Even after surgery, the frozen shoulder can recur in 5-10%.

What if the Frozen Shoulder is left untreated?

The duration of disease continuation varies from patient to patient after the onset of frozen shoulder complaints. In the literature, it is seen that the disease persists for 3-10 years in untreated cases. Although this long period of time, it is possible that in many patients, shoulder mobility is almost completely restored. However, in some of the untreated frozen shoulder patients, movement limitation and sequellae remain.