Dull Shoulder

Adhesive capsulitis, or in other words, frozen shoulder syndrome, is a disease characterized by hardening of the soft tissues and joint capsule of the shoulder joint and causing difficulty in movement. It is more common in 5% of the general population and in women aged 40-60 years.

The exact cause of frozen shoulder syndrome is not known. In the first stages, an inflammatory reaction develops and the shoulder joint swells by forming edema. Later, this fluid freezes to form stiffness in the capsule surrounding the shoulder joint and in the intra-shoulder ligaments.

Frozen shoulder syndrome can also occur after previous trauma or surgery. These are called secondary frozen shoulder syndrome. Its pathology is the same as primary frozen shoulder syndrome of unknown cause.

Presence of frozen shoulder syndrome on the opposite shoulder, endocrine system diseases such as diabetes and thyroid, cardiovascular system diseases, neurological diseases such as stroke, Parkinson’s are risk factors for the formation of frozen shoulder syndrome.

The first stage of frozen shoulder disease is the edema stage. It is the first 2.5 -3 months period. There is pain, which is more at night. Since the stiffness in the joint capsule is still minimal, there is a certain level of movement when the shoulder is moved passively.

The second stage is the freezing stage. It is a period of 3 months – 1 year. Movement is restricted. Since the inflammation phase is over, there is no inflammatory pain, but there is severe pain at the time of movement due to freezing.

The third phase is the dissolution phase. It is a period of 1 year-3 years. Spontaneous gradual improvement is observed in shoulder movements and functions.

Frozen shoulder syndrome can be diagnosed mainly by physical examination. Thickening and narrowing of the capsule with MRI can help in the diagnosis. Other pathologies and bone density reduction that may occur due to the disease can be detected with X-ray.

Non-surgical treatment is preferred first in frozen shoulder syndrome. Oral anti-inflammatory drugs may be more effective in pain control than in the treatment of the disease. Likewise, using oral cortisone in the first stage of the disease is effective in short-term pain control and providing range of motion.

When cortisone injections into the joint are combined with physical therapy, it is a highly effective application. However, the injection must be made fully into the capsule. Every cortisone application to the shoulder may not provide the same benefit in terms of anatomical target points.

Surgical treatment is applied in patients whose pain and range of motion do not improve despite 6 months of treatment. Adhesions on the shoulder are cleaned with arthroscopic, that is, closed methods, and the joint capsule is loosened by cutting. Open surgery is rarely preferred in cases of frozen shoulder syndrome secondary to severe trauma.

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