Frozen shoulder is a pathology also known as retractile capsulitis that causes a progressive decrease in shoulder mobility due to inflammation and retraction of the ligaments of the glenohumeral joint. The cause of this disease is unknown and it is more frequent in the female sex and in diabetic patients.
Symptoms of frozen shoulder
In the initial phase, the shoulder is very painful and with marked nocturnal pain. As the disease progresses over time and enters the frozen phase, the pain decreases but the shoulder becomes stiff, with less mobility and this lasts for many months.
Diagnosis of frozen shoulder
The diagnosis of retractile capsulitis is clinical and will be made by the physician or orthopedic specialist through the history and clinical examination of the patient. Additional diagnostic tests are of little help, but an ultrasound and x-rays will rule out other causes of painful shoulder.
Recovery of frozen shoulder
The natural evolution of this disease is to spontaneous healing within 18 months, although the time is very variable. The frozen shoulder will go through three phases:
- First, the inflammatory phase, which can be very painful.
- Then it will go through the stiffness or freezing phase of the shoulder, with decreased pain and the appearance of severe stiffness of the joint.
- In the third or resolution phase, progressive recovery of mobility finally occurs.
In some patients, marked limitation of mobility may remain without spontaneous recovery.
Treatment of frozen shoulder
Treatment should be individualized according to each patient and the stage of the disease.
Also in the initial inflammatory phase with severe pain in the shoulder, it is advisable to take anti-inflammatory and analgesic drugs. In addition, the shoulder should be kept in relative rest, avoiding movements that provoke pain. One or two intra-articular injections of a delayed-action corticosteroid are very useful in relieving pain and shortening the healing time of this disease.
There is also the possibility of semi-invasive treatment in a pain unit. When the pain subsides, very gentle and painless capsular stretching exercises should be performed several times a day.
In the advanced stage of frozen shoulder when the patient has a marked decrease in mobility, but less pain, the physician will recommend a mild anti-inflammatory treatment. He will also prescribe capsular stretching exercises to be performed several times a day, as well as physical therapy but always without causing pain in the shoulder.
The vast majority of patients with patience respond positively to this treatment if they do the exercises continuously.
It is scientifically proven that shrunken collagen tissue, such as that of retractile capsulitis, with the passage of time and applying multiple cycles of stretching recovers its initial length.
The various types of exercises for stretching the shoulder in all directions should be performed carefully, slowly, until you feel a tension or discomfort in the shoulder, this is the sign that is stretching the ligament that is shrunk. This sensation of discomfort or tension should be maintained for a few seconds and then return to the initial position.
It is recommended to perform 10 stretches in each of the five positions and repeat five times a day. Patient performing a shoulder capsular stretching exercise.
Treatment of frozen shoulder with arthroscopy
If after conservative treatment correctly performed for months, shoulder mobility is not restored, shoulder arthroscopy is recommended to mobilize the shoulder under anesthesia. This procedure is rarely indicated since the vast majority of patients recover with conservative treatment.
The postoperative period is very important and a physiotherapeutic treatment of capsular stretching will be applied several times a day, even with the aid of anesthesia to avoid any pain, and thus recover an acceptable range of motion in a few weeks, although full recovery may take some time.