Frozen shoulder

From greek.doctor
  • Frozen shoulder = adhesive capsulitis of the shoulder (= periarthritis of the shoulder)
    • = inflammation of the joint capsule which shrinks it and makes movement painful
    • Can be idiopathic (primary) or secondary to diabetes, thyroid disease, etc.
    • Pathomechanism
      • Inflammation of the joint capsule makes movement of the shoulder painful
      • Pain causes the shoulder to be less frequently used
      • Lack of use and inflammation causes the shoulder capsule to thicken and adhere to itself and the humerus -> the symptoms become progressively worse
      • In the “end-stage” adhesive capsulitis the shoulder cannot be moved at all -> frozen shoulder
    • Stages
      • Freezing stage – pain and limited motion
      • Frozen stage (frozen shoulder) – less pain, no motion
      • Thawing stage – symptoms improve
    • Clinical features
      • Restricted and painful movements of shoulder
        • Especially internal and external rotation
    • Diagnosis
      • Adhesive capsulitis is a clinical diagnosis based on decreased movement without underlying disease
      • Negative X-ray
      • MRI may show soft tissue inflammation
    • Treatment
      • It’s usually self-limiting
      • Conservative
        • NSAIDs
        • Physiotherapy
      • Surgical
        • Manipulation under anaesthesia (MUA)
          • (Not so much used anymore)