| Introduction |
| In
1934, Codman described the frozen shoulder as a condition which is
difficult to define, difficult to explain and difficult to treat.
Codman’s description remained true until 10 years ago. But, with the
advent of shoulder arthroscopy, understanding of this condition and
treatment has significantly improved. |
| Periarthritis Is A Misnomer |
| We
now clearly know that there is no involvement of glenohumeral joint.
So, periarthritis is a misnomer. It is the capsule which is diseased.
So, pericapsulitis is also a misnomer. The terms which closely describe
the condition are adhesive capsulitis and frozen shoulder. There is
widespread consensus among the shoulder specialists that “contracted
shoulder” is the most appropriate term to describe this condition. |
| What Is It? |
Frozen shoulder is characterized by two principal features’
Sudden onset of pain and stiffness in a previously normal shoulder is frozen shoulder until proved otherwise. |
| Types: |
| The
Frozen Shoulder can be of two types, primary or secondary. Primary is
the most common type with no specific etiology. The secondary frozen
shoulder can be due to trauma, infection, or surgery. The primary frozen
shoulder can be associated with the lot of medical conditions. |
| Associated Conditions: |
| Diabetes
is a very specific risk factor for developing frozen shoulder. 20% of
the diabetics have frozen shoulder at some point of their lifetime. This
rises to 36% in insulin-dependent diabetics. In diabetics, it is often
bilateral and resistant to treatment. The etiology is probably auto
immune in origin. The other associated conditions are thyroid disorders,
ischemic heart disease, post-cardiac surgery, hyperlipidemia, and other
neurologic conditions. |
| Differential Diagnosis : |
| The
frozen shoulder should be differentiated from other conditions like
biceps tendon pathology, brachial neuritis, cervical disc disease,
chronic regional pain syndrome, Pancoast's tumour, hemiplegia, and
rotator cuff disease. |
| Treatment: |
The treatment of the frozen shoulder depends on the stage of presentation.
- Stage 1 (pain) : Treated with intra-articular steroid and medications for the neuropathic pain.
- Stage 2 (pain + stiffness):Treatment by manipulation under
anaesthesia , steroid injection and followed by aggressive
physiotherapy.
- Stage 3 (stiffness):Treatment by arthroscopic surgical release.
|
