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Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder is a condition characterized by pain and restricted shoulder movement. Although the disease is not yet fully understood, there is an inflammatory process that causes thickening and tightening of the shoulder capsule.

Similar to any joint in our body, the shoulder joint has a capsule that surrounds the structures forming the shoulder joint. In a normal shoulder, the capsule is soft and flexible, allowing the shoulder to move in a wide range of motion. In frozen shoulder syndrome, the capsule becomes inflamed and contracts, reducing the joint's volume. As a result, shoulder movement is restricted and causes shoulder pain. Additionally, the ligaments embedded within the capsule are affected, thickening and becoming stiff, further limiting shoulder motion.

What are the Causes of Frozen Shoulder?

Although the exact cause of frozen shoulder syndrome is not fully known, several conditions are commonly present in patients:

  • Hormonal Disorders:It is frequently seen in individuals with diabetes and thyroid disorders. The incidence of frozen shoulder is also higher in women during menopause. It is more common in male patients with imbalanced testosterone levels.

  • Shoulder Trauma: Many patients may not initially recall it, but upon detailed questioning, they may have experienced a simple shoulder injury. Frozen shoulder syndrome can also occur after the healing process of fractures around the shoulder.

  • Cervical Herniation: Patients with frozen shoulder syndrome often have various disc problems in the neck vertebrae. The severity of these disc problems may vary from patient to patient, ranging from a simple disc protrusion to a herniated disc requiring surgery.

  • Post-Open Heart Surgery: Some patients who have undergone open-heart surgery may develop frozen shoulder.

  • Stress: When no apparent cause is found in patients, they often report a recent period of high stress.

  • Parkinson's Disease Patients

  • Cardiac Patients

What are the Symptoms of Frozen Shoulder?

Frozen shoulder syndrome has two main symptoms: shoulder pain and restricted shoulder movement:

  • Omuz Ağrısı: It is an increasingly worsening pain that wakes patients up from sleep, affecting the shoulder and arm. The pain is often felt in the front and side of the shoulder. Patients also complain about not being able to sleep on the affected shoulder. Over time, the pain intensifies, and they become unable to perform routine daily movements such as brushing teeth, shaving, or combing hair.

  • Limited Range of Motion: Initially, there is minimal movement restriction, which gradually increases over time. When patients attempt to increase their range of motion, the pain intensifies.

Frozen shoulder has three stages, and as the stages progress, the pain and limited movement increase. These stages are as follows:

Stage 1: "Freezing" stage. In this stage, the shoulder becomes highly inflamed and painful, often accompanied by night pain. As the shoulder capsule contracts, movement becomes more restricted. This stage can last between 6 weeks and 9 months.

Stage 2: "Frozen" stage. In this stage, the pain gradually settles, but the restriction of movement persists. This stage can last from 4 to 12 months.

Stage 3: "Thawing" stage. Movement gradually returns to the shoulder. The duration of this stage varies, but it can last between 6 and 36 months. Even at the end of this stage, some limitations in shoulder movements may remain.

How is Frozen Shoulder Diagnosed?

Pain and stiffness are common symptoms in many shoulder conditions. Therefore, the diagnosis of frozen shoulder can only be made after careful history-taking and examination. Experienced shoulder surgeons can detect frozen shoulder even in its early stages. However, radiological imaging methods such as X-ray and MRI are used for the differential diagnosis of frozen shoulder.

How is Frozen Shoulder Treated?

Intra-articular Cortisone Injection and Physiotherapy

  • If frozen shoulder is caught in its early stage, it can be resolved without progression through ultrasound-guided intra-articular cortisone and hyaluronate injections and aggressive physiotherapy. In some cases, a single injection may not be sufficient, and 2 or even 3 injections may be required.

  • Pain relievers, especially NSAIDs, can be used to reduce pain. However, pain relievers do not have an effect on increasing the range of motion.

  • After the intra-articular injection, effective treatment for frozen shoulder can be achieved through manual therapy performed by an experienced physiotherapist.

Manipulation Under General Anesthesia

  • The patient receives anesthesia in the operating room and shoulder movements are carefully manipulated. The patient is kept in the hospital for a few hours for pain control after the procedure.

  • Manipulation under general anesthesia often leads to satisfying results in most patients. In addition to the intra-articular cortisone injection performed during the same session, regular physiotherapy after the procedure is crucial.

When is Frozen Shoulder Surgery Performed?

Surgery for frozen shoulder is planned when non-surgical methods are ineffective. However, the rate of requiring surgery for frozen shoulder is quite low after the methods mentioned above.

How is Frozen Shoulder Surgery Performed?

Frozen shoulder surgery is performed arthroscopically, which means it is done through small incisions of 2-3 centimeters in the front and back of the shoulder. The stiffness of the capsule, which limits shoulder movement, is released. In order to achieve greater joint range of motion, a gentle manipulation of the shoulder is usually performed during the same procedure. A physiotherapy program after surgery is always an important part of the treatment.


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