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The Multifactorial Problem of Frozen Shoulder

The Multifactorial Problem of Frozen Shoulder
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The condition that’s often referred to as frozen shoulder goes by many monikers: adhesive capsulitis, painful stiff shoulder, periarthritis, and idiopathic restriction of shoulder movement. Regardless of the name, frozen shoulder presents itself as a stiff, inflexible, and painful shoulder joint and it often arises in a mysterious way that’s sometimes difficult to trace. The etiology of frozen can be primary (typically, no known cause) or secondary to other conditions. Because of its often nebulous onset, there is great debate in the scientific literature regarding how to best manage the condition.

Frozen shoulder affects up to 5% of the world’s population, usually those between the ages of 40 and 60 years, and between 10% and 38% of those with diabetes or thyroid diseases. In addition to diabetes and thyroid diseases, other risk factors for frozen shoulder include Dupuytren’s syndrome, kidney stones, cancer, Parkinson’s disease, shoulder injury, smoking, post-stroke, heart and neck surgery, and chronic regional pain syndrome. Up to 85% of frozen shoulder patients have at least two risk factors for frozen shoulder, and nearly 40% have at least three!

Frozen shoulder is considered an inflammatory condition that causes fibrosis of the glenohumeral ball and socket joint capsule that leads to gradual progressive stiffness and significant loss of motion, especially external rotation.  In its early stages, differentiating frozen shoulder from other shoulder pathologies can be quite challenging, but the process becomes much easier in its later stages. Erroneously, many healthcare professionals believe that frozen shoulder spontaneously resolves in most patients. Rather, the condition can persist for years and may never resolve if left untreated.

Generally, initial treatment for frozen shoulder is usually physical in nature including a mix of manual therapies, physical therapy, and patient-specific home exercises.  Medical doctors may administer steroid injections or prescribe medications that can provide temporary relief, but since they have little impact on the accumulation of fibrotic collagenous scar tissue, the symptoms will likely return. If conservative options fail, surgical methods like open or arthroscopic capsular release and hydrodilation may be recommended to improve shoulder range of motion and alleviate pain, but these procedures may lead to complications.

As with many musculoskeletal conditions, frozen shoulder is easiest to manage in its earliest stages. Because of the nature of frozen shoulder, co-management to address comorbidities with the patient’s medical doctor may be necessary to achieve the best possible outcome in the shortest time.


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