Frozen shoulder

With frozen shoulder – as the name implies – movement of the shoulderis severely restricted. This condition, medicallyreferred to as adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain. Rheumatic diseaseprogression and recent shoulder surgerycan also cause frozen shoulder. Intermittent periods of use may cause inflammation.

Adhesions(abnormal bands of tissue) grow between the jointsurfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricatesthe gap between the armboneand socket to help the shoulder joint move. It is this restricted space between the capsule and ball of the humerusthat distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder. People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or who have been in an accident, are at a higher risk for frozen shoulder. The condition rarely appears in people under 40 years old.

Prevention

To prevent the problem, a common recommendation is to keep the shoulderjointfully moving to prevent a frozen shoulder. Often a shoulderwill hurt when it begins to freeze. Because pain discourages movement, further development of adhesionsthat restrict movement will occur unless the jointcontinues to move full range in all directions. Physical Therapywill help one continue movement to discourage freezing. A medical doctorreferral is needed before physical therapycan begin under lawin many places.

Signs and diagnosis

With a frozen shoulder, one signis that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. People complain that the stiffness and discomfort worsen at night. A doctor, or physical therapist, may suspect the patient has a frozen shoulder if a physical examinationreveals limited shoulder movement. Frozen shoulder can also be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder). An arthrogrammay confirm the diagnosis.

Management

Management of this disorder focuses on restoring joint movement and reducing shoulder pain. Usually, it begins with nonsteroidal anti-inflammatory drugs(NSAIDs) and the application of heat, followed by gentle stretching exercises. These stretching exercises, which may be performed in the home with the help of a physical therapist, are the treatment of choice. In some cases, transcutaneous electrical nerve stimulation(TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses.

If these measures are unsuccessful, the doctor may recommend manipulationof the shoulder under general anesthesiato break up the adhesions. Surgeryto cut the adhesionsis only necessary in some cases.

References

1. This article contains text from the public domain document "Questions and Answers about Shoulder Problems", NIH Publication No. 01-4865, available from URL http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htmzh:????????

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Frozen+shoulder Wikipedia article Frozen shoulder.