Frozen Shoulder Disease

Frozen shoulder disease (frozen shoulder, adhesive capsulitis, frozen shoulder)
Frozen shoulder disease is a condition characterized by pain and limitation of movement in the shoulder joint. Symptoms typically have an insidious onset, with complaints increasing and progressing over time, and the recovery period can vary between 1 and 3 years.

Who is most likely to have frozen shoulder?

Frozen shoulder is more common in women between the ages of 40 and 60. Diabetes is the most important risk factor for frozen shoulder. In addition, the risk of developing frozen shoulder is high in patients with thyroid gland diseases, stroke, after breast or heart surgery, Parkinson’s disease and individuals with immobilized shoulders for a long time. It can be bilateral in one third of patients. Shoulder motion limitation may also develop after fractures or surgeries around the shoulder, but the course and treatment of these are different.

How does frozen shoulder disease occur?
Frozen shoulder occurs when the tissues surrounding the joint, especially the joint capsule, thicken and harden. The thickened and shortened tissues hinder the movements of the shoulder joint. In general, frozen shoulder has a slow course and includes the following stages;

• Stage 1 (inflammatory stage): It is characterized by severe pain and limitation of movement in the shoulder. There may be pain at night, movements of the shoulder are painful in all directions. This stage lasts approximately 1-3 months.
• Stage 2 (freezing stage): It is seen between 3-14 months after the onset of the disease and the pain gradually decreases but the limitation of movement is evident.
• Stage 3 (Resolution stage): This occurs between the 15th and 24th months after the onset of the disease, when the pain subsides and shoulder movement gradually returns. By the end of the second year, most signs of the disease have subsided, but about one-fifth of patients still have uncomfortable pain and restricted movement.

How is frozen shoulder disease treated?
The primary treatment for frozen shoulder is non-surgical methods. Anti-inflammatory drugs and intra-articular cortisone injections are useful for pain control. In the initial stages, careful stretching exercises and ice applications that do not increase inflammation are performed. After the frostbite phase and when the pain subsides, more demanding physical therapy methods can be used.
In patients who do not respond to at least 6 months of treatment, manipulation (mobilization) can be performed under general anesthesia. During manipulation, after complete muscle relaxation is achieved, the shoulder capsule is loosened with various maneuvers and the shoulder is mobilized.
The shoulder movements gained are preserved with a serious rehabilitation program to be done afterwards. If shoulder movements cannot be regained with manipulation, shoulder movements can be regained with arthroscopic surgery. During arthroscopy, thickened soft tissues that prevent movement are cut and loosened.
The subsequent rehabilitation program is similar to manipulation. Frozen shoulder may recur in 5-10% of patients.