Frozen Shoulder Extra

• Frozen Shoulder:

  • aka adhesive capsulitis
  • describes a fibrotic and inflammatory contracture of the rotator cuff, capsule and ligaments
  • incidence:
  • 2 to 5% of the population, with females 4 times more likely to get it
  • more likely to affect the nondominant shoulder
  • affects middle aged people usually (40 to 60 years old)
  • can occur secondary to trauma in the younger population
  • genetic component
  • can be related to gut microbiome and hormone levels
  • diabetics (10 to 20% can develop frozen shoulder)
  • contralateral recurrence 20 to 30%

  
• Photos through arthroscope:

  • left shoulder is normal
  • right shoulder shows frozen shoulder, characterised by inflammation, adhesions, lots of fibrotic deposits and a clear irritation of the synovial membrane

  
• Frozen Shoulder:

  • possible risk factors:
  • diabetes mellitus - prevalence up to 20%
  • stroke
  • thyroid disorder
  • following shoulder injury/trauma
  • Parkinson disease
  • cancer
  • complex regional pain syndrome
  • potential link to gut health (chronic inflammation/metabolic syndrome)
  • frozen shoulder is thought to occur when a primary insult to the shoulder triggers a complex cascade and upregulation of growth factors and cytokines with an increased turnover of the extracellular matrix, activation of myofibroblasts with deposition of collagen and reduced matrix degradation
• Take Home Message:

  • frozen shoulder is a self-limiting condition with a favourable outcome, especially when diagnosed early
  • however to achieve satisfactory results and optimise recovery, physiotherapy plays a key role in management of frozen shoulder