Let’s take a look at frozen shoulder.
AKA adhesive capsulitis.
Frozen shoulder is a chronic shoulder condition typically lasting 1.5 – 2 years; but can be triple that. It is characterised by both pain and restricted movement. The cause is often unknown, though it is related to immobility of the shoulder (eg after keeping your arm in a sling), previous injury to the shoulder, and to diabetes. The process is one of inflammation and contraction of the shoulder capsule, often with some scar formation within the joint itself.
Classically, frozen shoulder goes through three phases
Freezing/painful phase: Gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhere from 3-9 months.
Frozen/stiffening phase: Pain starts to subside, progressive loss of glenohumeral motion in capsular pattern. Pain is apparent only at extremes of movement. This phase may occur at around 4-6 months and can last for about 12 months.
Thawing/resolving phase: Spontaneous, progressive improvement in functional range of motion which can last anywhere from 1 to 4 years.
Conservative management of frozen shoulder does not really offer a cure, or reduce the duration; but attempts to reduce the severity of the symptoms – both pain and freezing; and is based around mobilisation, massage, stretching and strengthening. NB: because the goal of conservative management is for symptom reduction, not cure – it is impossible to know for sure if it is working or not.
Medical management of frozen shoulder is based around steroid injection to reduce inflammation, or manipulation under anaesthetic to break down scar tissue.
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