HEALTH TIPS: FROZEN FUTURE (CAPSULITIS ADHESIVE)

Dr. Tariq Jagnarine
Family Medicine, Endocrinology / Diabetes

Frozen shoulder is commonly known as sticky capulitis, which is a shoulder condition that limits the range of your motion. When the tissues in the shoulder joint become thicker and tighter, scar tissue develops over time, which limits the range of motion of the shoulder, with the joint not having enough space to rotate properly.
Common symptoms of this condition include swelling, pain and stiffness; and this condition is more frequent between the ages of 40 and 60 years.

BASIC FUTURE CASES
Having a hormonal imbalance, diabetes, or a weakened immune system makes individuals more prone to joint inflammation. A prolonged period of inactivity due to injury, illness or surgery also makes people more susceptible to inflammation and adhesion, which are bands of stiff tissue. In severe cases, scar tissue can form, which severely limits the range of motion of the shoulder. The condition usually takes two to nine months to develop.

FROZEN FUTURE RISK GROUPS
Common risk factors for a frozen shoulder are:
* Age: Be over 40 years old.
* Gender: 70 percent of people with a frozen shoulder are women.
* Recent trauma: Surgery or an arm fracture can lead to immobility during recovery, which may make the shoulder capsule stiffen.
* Diabetes: 10 to 20 percent of people with diabetes develop a frozen shoulder, and symptoms can be more severe. The reasons are unclear.

Other conditions that may increase the risk are:
* Stroke
* Hyperthyroidism, or overactive thyroid
* Hypothyroidism, or underactive thyroid
* Cardiovascular disease
* Parkinson’s disease

SYMPTOMS
People can become aware of a frozen shoulder when it starts to hurt.
* The pain then results in limited movement of the shoulder.
* Moving the shoulder less and less increases its stiffness.
* Ultimately, individuals cannot move the affected shoulder as they once did. Getting to an item on a high shelf becomes difficult, if not impossible.
* When it’s serious, everyday tasks that involve moving a shoulder, such as dressing, it becomes a huge task.

ACTION
Symptoms are usually classified in three stages, as they gradually get worse and then resolve within a period of 2 to 3 years. The American Academy of Orthopedic Surgeons (AAOS) describes three steps:
* Freezing, or painful phase: Pain gradually increases, making shoulder movement harder and harder. Pain tends to be worse at night. This stage can last from 6 weeks to 9 months.
* Frozen: Pain does not get worse, and may decrease right now. The shoulder remains stiff. It can last 4 to 6 months, and movement can be restricted.
* Melting: Moving becomes easier and may eventually return to normal. Pain may fade but sometimes recur. This takes between 6 months and 2 years.
Over 90 percent of people find that symptoms, with simple exercises and pain management, improve. A frozen shoulder usually heals, but it can take 3 years.

DIAGNOSIS
The feeling of pain with shoulder stiffness would be one of the first signs of a new frozen shoulder. A physical exam would help assess the range of motion through specific movements, such as touching the shoulder opposite the other hand.
A few tests may also be needed, such as an X-ray to check for arthritis or other abnormalities. Sometimes an X-ray arthrogram is needed for this, which involves injecting dye into the shoulder joint to help visualize the structures in more detail.
* Magnetic resonance imaging (MRI) scan to rule out rupture of the rotator cuff or other pathology.

TREATMENT
Conservative Therapy: It involves leaving a frozen shoulder untreated, but the pain and stiffness can last up to three years. A combination of the following can speed up the recovery and help with the symptoms:
* Physical therapy
* Medication
* Surgery
* Home care

Physical Therapy
Physical therapy is the most common treatment for a frozen shoulder. The goal is to extend the shoulder joint and regain the lost motion. The results can take as long as a few weeks to nine months to sort out. A home exercise program of a gentle range of motion exercises is important. If no change is seen after six months, consider alternative treatment methods.

Medicines
To treat the pain and reduce joint inflammation, it is recommended to use an anti-inflammatory medication such as aspirin, ibuprofen, or sodium naproxen or diclofenac. A steroid injection in the shoulder joint may also help.

Home Care
Placing an ice pack on the shoulder for 15 minutes at a time several times a day can help reduce pain. Physical therapy exercises can be done at home. Most people with a frozen shoulder can improve their condition without surgery.

Surgery
If physical therapy does not cure the condition, surgery is an option. From a surgical point of view, the options include treating the shoulder and putting it through a full range of motion under general anesthetic to help break down any adhesions. Another option is arthroscopic surgery. This type of surgery involves making a small incision in the shoulder and using a camera called an “arthroscope” to remove or release scar tissue. This allows the shoulder to restore its lost motion.
If the frozen shoulder is the result of an injury, surgery is usually more successful if performed within a few weeks of the injury. Surgery is usually done as an outpatient. Post-operative physical therapy is also usually required.
Many patients have their full range of motion back within three months. Some people still have pain or stiffness afterward, or they can’t handle the pain of physical therapy.

PROGNOSIS
Most people recover within two years without treatment. Physical therapy and pain medications accelerate this progress. If surgery is required, it is important to continue the therapy exercises in the following months, so that the problem does not return. Early treatment helps keep the condition from getting worse.
People who are diabetic need to manage their blood sugar levels properly to help reduce the risk of holding a frozen shoulder.
A frozen shoulder cannot be stopped if it is caused by an injury that makes it difficult to move a shoulder. Anyone experiencing such an injury should consider exercises for maintaining mobility and flexibility of the shoulder joint.