Frozen shoulder is an inflammation of the shoulder that will cause the patient continuous and repeated pain, which will subsequently affect the patient’s ability to carry out daily activities.
Frozen shoulder syndrome occurs when the flexible tissue that surrounds the shoulder joint, called the capsule, becomes inflamed and thickened.
Among shoulder conditions, adhesive capsulitis is one of the least understood.
What are the symptoms of frozen shoulder?
The different symptoms of this syndrome are:
– shoulder pain that comes on gradually
– difficulty performing daily movements
– continuous pain for several weeks or even months, with onset of stiffness and difficulty in moving the shoulder.
Symptoms tend to get progressively worse over a number of months or years.
Factors that increase the risk of developing frozen shoulder syndrome
There are several factors that increase the risk of developing a frozen shoulder and they are:
– a previous shoulder injury or operation
– diabetes
– Dupuytren’s disease (a condition characterized by the formation of small bumps of thickened tissue in the hands and fingers)
– heart disease
– a cerebral vascular accident
– problems with the thyroid gland
This syndrome is most common in people between the ages of 40 and 70, with one in 50 people affected each year. In addition, women are significantly more affected by this syndrome than men.
After a first episode of frozen shoulder syndrome, it is found that 10% of people can develop a frozen shoulder on the other side within 5 to 7 years of the first recovery.
Frozen shoulder syndrome is characterized by 3 phases:
The freezing phase (phase 1) : it can last from 2 to 6 months. Clinically, stage 1 is mainly characterized by moderate to severe pain and partial restriction of mobility.
From a pathological point of view, it is characterized by the slow onset of generalized inflammation affecting the shoulder joint, which leads to the gradual appearance of “pain” as the main symptom.
Simple pain and terminal loss of range of motion at the onset of the freezing phase may be confused with rotator cuff tendinopathy, as the latter also presents with painful terminal loss of range of motion.
However, range of motion does not progressively worsen in rotator cuff tendinopathy, whereas it continues to worsen with each follow-up in adhesive capsulitis.
Frozen Stage (Stage 2) : it can last from 4 to 12 months. Clinically, this stage is characterized by pain and stiffness in varying proportions. At the beginning of this second phase, patients have more pain. Later, the stiffness takes precedence over the pain.
Pathologically, it is characterized by a gradual decrease in inflammation and the appearance of extensive fibrosis of the capsule and ligaments, which leads to a significant restriction of mobility.
Thawing phase (stage 3) : it can last from 6 to 26 months. Clinically, this stage is characterized by minimal pain and gradual resolution of stiffness. Pathologically, it is characterized by progressive resolution of inflammation and fibrosis, resulting in minimal pain and gradual return of movement.
Non-drug treatment of frozen shoulder
Manual therapies and rehabilitation exercises are among the first-line treatments for frozen shoulder. The therapists work on three axes: pain reduction, mobilization and muscle strengthening.
The decrease in pain can be sought by different techniques, including laser or the application of heat, for example. Mobilizations of the joint, associated with rehabilitation exercises, then make it possible to work on the range of motion.