The Agony of Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis or frozen shoulder syndrome, is a common painful disorder characterized by a relatively long duration and limited range of motion in the shoulder.  The length of time the frozen stage of the disease can last is anywhere from 1 to 3.5 years with a mean of 30 months.

frozen-shoulderIncreased capsular collagen thickening and capsular contraction in the shoulder joint causes restriction in both active and passive range of motion in the shoulder.   Adhesions also develop that tether the joint surfaces. As the condition gets worse, pain can become more severe and is accompanied by stiffness and decreased range of motion. The stiffening may increase to the point where even the natural arm swing that goes along with normal walking is lost.   Pain at night is often unbearable.

The diagnosis is made using a combination of history and physical diagnosis.  Confirmation can be made using magnetic resonance imaging or diagnostic ultrasound.

The most common treatments for frozen shoulder currently are long-term intensive and aggressive physical therapy, corticosteroids administered by injection, manipulation under anesthesia and arthroscopic surgery.  Depending on the series and studies cited, the results of the different treatment modalities vary widely. Also, each treatment has associated risks.

Drugs are often used to manage the pain, but none have been demonstrated to have an impact on the course of frozen shoulder.

Frozen shoulder is estimated to affect approximately two to five percent of the general adult population.  Certain conditions are associated with an increased occurrence of frozen shoulder.  These include diabetes, Dupuytren’s contracture, trauma, a previous history of frozen shoulder, and thyroid disease.

The condition tends to occur in a patient’s fourth to sixth decade of life.   Frozen shoulder occurs slightly more often in women than in men and often presents bilaterally.  Unfortunately, it may affect the opposite side years after onset of symptoms in the first shoulder; however, it does not typically affect the same shoulder twice.

Recently the use of an injectable drug called collagenase clostridium histolyticum has been studied in clinical trials.  This is the same drug used to treat Depuytren’s contracture. The theory is that this drug may digest the excess collagen that accounts for the adhesions that are the ostensible perpetrators of the frozen shoulder. However, there is concern that this substance may also affect the normal cartilage of the shoulder.

Spontaneous remission is the usual course for many patients. However, this remission may take several months or years to take place.

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