Frozen shoulder damaging the life quality in a significant way is characterized by pain and developing movement restriction. The frozen shoulder which is seen in persons at the age of 40 and above and in women causes the strong connective tissue surrounding round edge of upper arm bone and fixing it in the joint to adhere, get thick and get inflammation. This situation restricts synovial liquid lubricating the joint and preventing abrasion and causes pain and frozenness.
Frozen shoulder has 3 stages.
- The first stage is tarnishing phase. Connective tissue called shoulder capsule gets more inflammation. Pain and freezing increase and the joint cannot be moved easily. Symptoms get more severe at night.
- The second stage is freezing phase. During this period, the shoulder has the stiffest form and moves difficult. It takes 4 months – 1 year. Even though pain decreases in this stage, the patient has difficulty during daily activities such as having meal, changing clothes, etc.
- The third stage is resolving phase. Pain starts to mitigate and the patient gradually regains moving ability.
What are the Symptoms of Frozen Shoulder?
The first compliant of frozen shoulder is shoulder pain which prevents sleeping. The pain increases when moving the shoulder. It causes movement restriction and prevents you to carry out daily activities. After a while, you are unable to move or twist your arm.
What are the Causes of Frozen Shoulder?
- Keeping the shoulder stable for a long time after traumas such as falling, hitting,
- Osteoarthritis of the shoulder, full and partial ruptures not treated in a timely manner
- Keeping the shoulder stable after shoulder surgeries underwent for muscle rupture or fracture,
- Heart attack or cardiac surgeries may cause a frozen shoulder.
The basic factor of the frozen shoulder is keeping the shoulder stable for a long time. Therefore, recommended exercises should be done to protect shoulder health and range of motion. Postponing of the treatment causes restriction in the motion of the patient and long recovery period.
How is Frozen Shoulder Diagnosed?
The physician acquires information about the symptoms and medical history of the patient.
By lifting and twisting the arm, it is controlled if it causes pain and the range of motion of the arm is checked.
X-ray is taken to determine if there is any other problem in the shoulder.
Stage of the disease is determined with imaging techniques such as computed tomography, MRI.
Treatment of Frozen Shoulder
Before treatment planning, it is necessary to determine stage of the disease. Proper treatment is started with the evaluation of symptoms, medical history, and shoulder joint movements. Non-surgical or surgical treatments can be applied.
Non-Surgical Treatment of Frozen Shoulder
For the first stage of frozen shoulder, a specific exercise program and medication are prescribed to prevent inflammation and pain.
Involuntarily exercises may cause an increase in the disease, therefore the exercise should be done with the assistance of a physiotherapist to enable the patient gain joint movements. Exercises are done for stretching and to increase range of motion.
In the event that sufficient recovery is not provided with physiotherapy, intraarticular steroid (cortisone) is injected.
Frozen Shoulder Surgery
If the complaints of the patient do not decrease despite anti-inflammatory medication, intraarticular injections, physiotherapy or manipulations (slow movement of the arm until the capsule and ligaments are released), surgical treatment is applied especially for third stage disease.
The aim of the treatment is to relax and stretch shoulder capsule. By removing adhesions in the shoulder joint capsule, restricted movements are aimed to be regained. The surgery will be successful if the patient maintains post-op physiotherapy exercises and strength and movement. In frozen shoulder surgery, arthroscopy method is used. Arthroscopic surgery is a type of closed surgeries. Imaging and treatment are performed entering 0.5 cm incisions without large incisions. While one hole is used to imagine the damaged area with a special camera and fiberoptic beams, the other hole is used to apply the treatment. The surgeon watches the surgical area on the high-resolution display and the treatment is carried out. For more information, you can read shoulder arthroscopy article.
What if Frozen Shoulder is not treated?
If frozen should is not treated, the patient may have restrictions in movement and disorder in the tissue and function. Also, the patient complains for long years. The duration of the disease varies depending on the patient, and according to the researches, it lasts 2-10 years from the starting date of the complaint. If there is movement restriction and it is not treated, significant function loss may be permanent in the shoulder.
After Frozen Shoulder Surgery
Generally, the patient is discharged the next day. The rehabilitation process is very important for the success of frozen shoulder surgery. Therefore, mild exercise is started right after the operation. Especially on the first day, the patient may complain about pain. The pain can be taken under control with simple pain killers. Physiotherapy is started next day. While the patients always complain about pain and movement restriction before the surgery, pain stops and movement restriction recovers completely or near completely.