DON’T DISCOUNT A FROZEN SHOULDER

Frozen shoulder, also known as ‘Adhesive Capsulitis’, is a condition that is overlooked frequently or misdiagnosed. The condition occurs due to the thickening/tightening of the capsule of the shoulder joint and is associated with inflammation of the joint space. Reduction in synovial fluid, which lubricates the joint spaces, is also observed.

Stiffness of the shoulder is the chief complaint along with pain that leads to difficulty in performing movements of the arm. Initially, the condition begins as slow onset pain in the region of the shoulder and/or upper arm, with an inability to sleep on the affected side. The discomfort can result in a restricted range of motion, which may disrupt the daily routine of the affected individual. Incidence of frozen shoulder is approximately 3-5% in the general population, with increased risk (of up to 20%) in diabetic individuals.

In a recent case of frozen shoulder, a 44-year-old male patient visited Wockhardt Hospital, Mumbai Central, and achieved immediate pain relief following Capsular Release by Shoulder Arthroscopy performed by Dr. Chintan Desai, Shoulder Surgeon, Wockhardt Hospital, Mumbai Central.

Dr. Chintan Desai said, “Our patient had stiffness and pain in the shoulder for approximately one year. He would find it difficult to lift his arms above his head, for example, while combing his hair, wearing clothes, etc. He was prescribed painkiller medications and advised physiotherapy exercises. However, he achieved only temporary relief from his symptoms, and did not regain his full range of shoulder/ upper arm movements." Dr. Desai advised an MRI to rule out possible tendon tears. After thorough investigations, the patient was advised to undergo Shoulder Arthroscopy and Capsular Release and had pain relief on the day following the procedure itself. Within a week he was able to resume normal active movements of the shoulder. The procedure of Capsular Release is done under arthroscopic vision; therefore, a precise release of the adhesions alone can be achieved without damaging the neighbouring tissues. Our patient was specifically advised to avoid strengthening exercises and was shown normal stretching exercises. With the combination of the minimally invasive treatment and physiotherapy, rapid pain relief and return to normal activities were facilitated”.

Radiographic imaging does not accurately depict the condition, except for Osteopenia (reduced density) of the affected shoulder bone. However, radiographs must be taken in order to rule out other Arthritic Pathology and Calcific Tendonitis. MRI investigation may be done to rule out muscle/tendon tear. Pathologically, frozen shoulder is associated with early inflammatory changes followed by formation of scar tissue (fibrotic reaction).

Conventionally, physiotherapy may be advised to strengthen the muscles along with pain-relieving medications. However, these modalities only provide temporary relief and generally require multiple sessions of prolonged duration. Moreover, exercising may be painful if the cause of the condition is not addressed. Sometimes, patients take as long as a year or more to recover. Even then, complete relief from restricted movements is not achieved.

Conservative therapy with USG guided injection has shown promise in the treatment of frozen shoulder. Under the guidance of ultrasound images, steroids, local anesthetic injections, and saline may be injected in order to expand the joint space. One or two sessions of this therapy may be performed at an interval of 2-3 weeks, combined with physiotherapy exercises. The purpose of the treatment is to reduce pain by distension of the joint space. However, one disadvantage of this therapy is that stiffness may persist for a period of one to two years.

Arthroscopy and Capsular Release have been described as the best therapy for frozen shoulder. The procedure is performed under local anesthesia as a ‘Daycare Procedure’, and therefore may be extremely beneficial in elderly individuals. Early detection is much better than handling an extremely painful condition.