Model Answer
0 min readIntroduction
Frozen shoulder, clinically known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint, significantly limiting its range of motion. It typically progresses through three distinct phases: freezing, frozen, and thawing. While the exact cause remains unclear in many cases (primary adhesive capsulitis), it is often associated with underlying medical conditions like diabetes, thyroid disorders, or previous trauma (secondary adhesive capsulitis). This progressive limitation of movement can profoundly impact daily activities and quality of life, making a thorough understanding of the condition crucial for effective management.
Understanding Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is a clinical entity affecting the glenohumeral joint, leading to progressive pain and restricted movement. It’s not arthritis, but rather an inflammatory process affecting the joint capsule.
Pathophysiology
The underlying pathophysiology involves inflammation and fibrosis of the glenohumeral joint capsule. This leads to thickening and contracture of the capsule, reducing the joint space and causing pain with movement. The exact trigger for this process is often unknown, but it's believed to involve an imbalance between inflammatory and reparative processes.
Types of Frozen Shoulder
- Primary Adhesive Capsulitis: Occurs without a clear underlying cause. It is idiopathic.
- Secondary Adhesive Capsulitis: Develops following a known injury, surgery, or systemic condition. Common associations include:
- Diabetes mellitus (prevalence is higher in diabetics)
- Hypothyroidism
- Hyperlipidemia
- Cardiac disease
- Stroke
- Post-surgical immobilization
Stages of Frozen Shoulder
The condition typically progresses through three overlapping phases:
- Freezing Stage (0-3 months): Gradual onset of pain, worsening with activity. Range of motion begins to decrease.
- Frozen Stage (3-6 months): Pain may plateau or decrease, but stiffness significantly increases, severely limiting shoulder function. This is the most debilitating phase.
- Thawing Stage (6-24 months): Gradual improvement in range of motion, with pain slowly subsiding. Full recovery can take several months to years.
Clinical Presentation
- Pain: Typically dull, aching pain in the shoulder, often radiating down the arm. Worse at night.
- Stiffness: Progressive limitation of both active and passive range of motion in all directions, particularly external rotation.
- Functional Limitations: Difficulty with activities requiring overhead reach, dressing, or reaching behind the back.
Diagnosis
Diagnosis is primarily clinical, based on history and physical examination. However, imaging studies can help rule out other conditions.
- Physical Examination: Assessing active and passive range of motion. Capsular pattern of restriction (external rotation > abduction > internal rotation).
- Radiographs (X-rays): To exclude other causes of shoulder pain, such as osteoarthritis or fractures.
- MRI: May show capsule thickening and inflammation, but is not always necessary for diagnosis.
- Ultrasound: Can visualize capsule thickening.
Management
Treatment focuses on pain control and restoring range of motion.
- Conservative Management:
- Physical Therapy: Stretching and strengthening exercises.
- Pain Medications: NSAIDs, analgesics.
- Corticosteroid Injections: Intra-articular injections can reduce inflammation and pain.
- Intervention Management:
- Manipulation Under Anesthesia (MUA): Breaking up adhesions under anesthesia.
- Capsular Release: Surgical procedure to release the contracted capsule. Reserved for severe cases unresponsive to conservative treatment.
Prognosis
Most cases of frozen shoulder resolve spontaneously over time, even without treatment. However, this can take several months to years. Early intervention with physical therapy and pain management can accelerate recovery and improve functional outcomes.
Conclusion
Frozen shoulder is a common and debilitating condition characterized by pain and stiffness in the shoulder joint. Understanding its pathophysiology, stages, and treatment options is crucial for effective management. While most cases resolve with conservative treatment, severe cases may require intervention. A comprehensive approach involving physical therapy, pain control, and, in some instances, surgical intervention, can significantly improve patient outcomes and restore shoulder function.
Answer Length
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