by Dr. Tan Boon Cheong
MBBS (MU),. MS Ortho (MU)
The shoulder is a region that commonly gives rise to pain and immobility. A common shoulder problem in orthopaedic practice is frozen shoulder or adhesive capsulitis. Frozen here does not mean cold temperature but it carries the meaning of the inability to move the shoulder joint in almost all directions as the disease progresses. Frozen shoulder is debilitating and will affect the daily activities of the patient. Frozen shoulder tends to heal over time, but full recovery may take up to three years.
It generally affects people between the age of 40 to 60 and more in females. The causes of frozen shoulder are not fully understood but there are a few factors which may present higher risks. Prolonged immobilisation after shoulder injury or surgery is one of them. Thus, early mobilisation is important. Diabetic patients (10% to 20%) are more prone to the ailment. They tend to have greater degree of stiffness and longer duration of the problem. Other medical conditions such as heart disease, thyroidal imbalance or Parkinson’s are linked to this malady as well.
The main symptoms are pain and stiffness. The pain is usually dull or achy in nature, typically in the outer part of the shoulder. Some patients may feel this pain at the upper arm. It gets worse at night, making sleep difficult. Symptoms of frozen shoulder can be categorised in three phases namely freezing, frozen and the thawing phase. Basically, the pain intensity slowly builds up to a stiffness that will lead to a debilitating phase before a slow recovery over time.
Diagnosis of frozen shoulder is based on clinical history and physical examination. Some imaging may be ordered to rule out other diagnosis if the history and examination are inconclusive.
Treatment of frozen shoulder is usually conservative with medication and physiotherapy. Shoulder joint injection with corticosteroid and joint distension with the injection of sterile water may sometimes be applied to reduce the symptoms. Shoulder joint manipulation under general anaesthesia can help in loosening the joint but is rarely needed or practiced. Surgery for frozen shoulder is seldom necessary.
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