Adhesive capsulitis - Thawing it out

There may be no known cause to a frozen shoulder but it can be cured with the right kind of treatment

Frozen shoulder (also known as adhesive capsulitis) is a condition characterised by stiffness and pain in the shoulder joint. It occurs when bones, ligaments and tendons that make up the shoulder joint are encased in a capsule of connective tissue. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.

Symptoms

Frozen shoulder develops slowly and in three stages:

Freezing — any movement of shoulder causes pain, followed by a progressive loss of range of movement.

Frozen — pain gets reduced but shoulder becomes stiffer, making it even more difficult to make any movement.

Thawing — gradual return of range of movement.

The symptoms begin gradually and worsen over time. “Most people aged between 40 and 60 years suffer from this illness and it takes almost 15 to 24 months for complete recovery,” says Dr Syed Imran Ahmed, a physiotherapist and assistant professor at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences. He adds the pain worsens at night and it becomes extremely difficult for patients to even perform simple tasks like changing clothes or taking a shower.

Causes

The main cause of the illness is not yet known. According to an estimate, it occurs in around 2% of the general population.

“Frozen shoulder is common among patients of diabetes, stroke, postpartum infection and those who have had prolonged immobilisation of their shoulder, for instance after an arm fracture or surgery,” says Resident Medical Officer at Orthopaedic unit, Civil Hospital, Dr Habibullah Memon.

Dr Memon refuted the misconception that stress causes frozen shoulder. “It’s a progressive illness as it has a slow onset of pain that increases over time,” he says, adding that men are more prone to the illness.

It should be noted that frozen shoulder is not a form of arthritis and other body joints are not affected, stresses Dr Ahmed.

Prevention

The best way to prevent frozen shoulder is through stretching exercises. “In some cases, nothing can prevent it,” says Dr Memon. However, for Dr Ahmed, the aim of such exercises is to reduce pain, increase extensibility of the capsule of the shoulder joint and improve strength of the rotator of cuff muscles.

Warm up properly before exercising to prevent any injury. Your doctor or physiotherapist can give you the precise treatment tailored to your needs.

Treatment

According to Dr Ahmed, patients should visit a place where all services, including painkillers, injection and physiotherapy, are available. Its treatment will vary depending on the stage of the condition and the severity of pain and stiffness. In many cases, people recover within 18 months, without undergoing any treatment, he adds.

More than 90% patients improve with simple treatments to control pain and mobilise their shoulders. Painkillers reduce pain, while physiotherapy and specific exercises help improve shoulder movement. “Some people are also recommended a steroid injection to relieve the symptoms for several weeks, which is not a permanent solution as the symptoms may return,” says Dr Ahmed.

Ishrat Ansari works on the Karachi desk at The Express Tribune.

Published in The Express Tribune, Sunday Magazine, November 15^th, 2015.