Frozen Shoulder Is A Surgical Disease

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

• Pain
• Stiffness

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.

 

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