Perhaps you yourself or someone from your loved ones have encountered an unpleasant disease, the so-called frozen shoulder syndrome. It is characterized by symptoms such as pain in the shoulder joint and limited mobility. This syndrome often occurs in people with diabetes after an injury or period of immobilization. Let’s see what the leading frozen shoulder causes and treatment methods are!
What’s Frozen Shoulder?
The shoulder joint is perhaps the only joint in which such a state of “frozenness” is noted. At the moment, there is no diagnosis as such, and this pathology is difficult to treat.
The more scientific name for the syndrome is adhesive capsulitis. Typically, range of motion is impaired on one side only, and most patients find it difficult to scratch their backs, get their hands in their trouser pockets, or button up a bra. About 2/3 of the patients who have consulted doctors with this problem are women, and the reasons for this distribution are not clear.
Shoulder pain is observed in the clinical picture of a number of not only neurological but also somatic diseases. Its prevalence reaches 26% of the general population.
It occurs in women 1.5 times more often than in men. Pain in the shoulder area can be a manifestation of a severe physical illness, and in this case, early diagnosis can save the patient’s life.
Therefore, shoulder pain deserves the most thorough and comprehensive study. However, shoulder pain often occurs due to damage to the joints (shoulder, acromioclavicular, and sternoclavicular) and surrounding soft tissues.
It has been shown that in elderly patients, about 65% of cases of shoulder pain are due to the pathology of the rotator cuff of the shoulder, 11% – soreness of the pericapsular muscles, 10% – pathology of the acromioclavicular joint, 3% – arthritis of the shoulder joint.
In 5% of cases, the pains are radiating from the cervical spine. The dominant and non-dominant limbs are affected with equal frequency.
Risk factors include:
- mature and old age; limiting the load on the joint;
- injuries (falling on the shoulder, falling on an outstretched arm), microtrauma (as a result of playing volleyball, basketball, hanging on a horizontal bar), overstretching of the ligamentous apparatus of the shoulder (lifting and carrying loads, stretching the arm forward when driving a large dog on a leash, etc.) or surgical interventions in the area of the shoulder joint;
- cardiovascular diseases;
- cerebrovascular diseases;
- endocrine pathology.
Frozen Shoulder Causes from a Medical Point of View
In more detail, frozen shoulder syndrome is a combination of fibrosis or contracture of the tendons, joint capsule, and other soft tissue surrounding the shoulder joint. Interestingly, this condition rarely occurs due to repetitive stress on the shoulder joint. More often, it appears due to the opposite – prolonged immobility.
As discussed above, the likelihood of this condition is associated with diabetes. It has also been linked to obesity and metabolic syndrome. Smoking is another risk factor (as it is generally a factor in the onset of many chronic pain types). About half of people with frozen shoulder syndrome also have Dupuytren’s contracture, a condition in which the fingers do not extend.
Main Frozen Shoulder Causes and Symptoms
Clinical manifestations are different in various periods of the disease.
The onset is usually spontaneous: pain in one shoulder joint increases over 1–3 weeks; pain is little associated with any specific movement, often worse at night, and when lying on a sore shoulder. The duration of the “painful” phase in the absence of treatment is from 3 months to a year, then the intensity of pain gradually decreases.
Then comes the “stiffness” phase – actually painless limitation of the range of motion in the joint. During this period of the disease, the characteristic appearance of the patient gave the name of the disease – “ankylosed” or “frozen shoulder.” This phase lasts from 4 to 12 months, followed by a resolution period, during which the range of motion in the joint is gradually restored.
In most cases, the disease ends with recovery, but half of the patients do not fully return to their original range of motion. The resolution phase lasts 12-24 months.
On average, the disease’s duration without treatment is from 1.5 to 2 years, but in some cases, it can reach four years.
There is a significant residual limitation of the range of motion in the shoulder joint in isolated cases.
Despite the overall good prognosis, during the entire period of the illness, the patient’s disability is limited. In the first two phases, they experience significant difficulties in self-care, which involves an active intervention to reduce the period of disability.
The classical phase course of the disease can be disrupted. So, during the period of acute pain subsiding, careless movement (jerking the arm, falling), rough manipulations with the joint can again increase the pain syndrome.
Infectious Cause of Shoulder Pain
Even with all precautions and antiseptic treatment, sometimes microorganisms can enter the joint when the probe is inserted into the shoulder. For example, there have been cases of ingestion of Propionibacterium acnes, a bacterium that, among other things, causes acne. P. acnes is likely to cause frozen shoulder syndrome, arthritis, and possibly sciatica.
There are certainly some risks of infection after surgery. But getting P. acnes at first is not even noticeable. It can look like a small inflammation. And then, this tiny inflammation caused by the body’s fight against infection develops into a “frozen shoulder.”
Other Possible Frozen Shoulder Causes
Although injections cause far fewer complications than surgery, they do carry some risks of infection. There were cases of disease after injections. There is even a name for this phenomenon – SIRVA, i.e., a shoulder injury associated with the vaccine administration.
Most injections are in the shoulder, as this area contains a large number of muscles. But sometimes, the doctor can “miss,” and the needle enters the joint capsule instead of muscle tissue. After a day or two, this becomes clear as the shoulder begins to hurt, and its mobility is impaired. Adhesive capsulitis develops according to the mechanism described above: P. acnes enters the joint capsule with a needle, and then inflammation occurs.
There is no evidence, but there is speculation that frozen shoulder may also result from systemic infections such as influenza or COVID-19.
There is also an opinion that frozen shoulder syndrome may be associated with the fact that a person does not use the shoulder joint “to the full” (does not throw projectiles, for example), and because of this, “stagnation” the risk of injury increases. Pietrzak put forward this opinion. However, it does not sound very plausible.
Another reason why frozen shoulder syndrome can develop is a painful functional limitation of mobility in the shoulder joint.
Frozen Shoulder Treatment
As with many other diseases, treatment is subdivided into medication and non-medication. A more reasonable, of course, is an integrated approach.
At different stages of the course of the disease has other goals.
At stage 1 – the use of painkillers and anti-inflammatory drugs and limiting the joint’s load to the tolerance limit.
During the 2nd and 3rd stage – the goal of treatment is to increase the range of motion in the affected joint, which is achieved by rehabilitation tactics.
Therefore, to achieve the maximum effect of treatment, it is necessary to do the following:
- Correct differential diagnosis
- Competent, including the osteopathic, correction of identified violations
- Muscle training, retraining of motor stereotype
The expected effect of osteopathic treatment due to the normalization of the connective tissue architectonics will be not only an improvement in blood and lymph circulation and normalization of joint function, but also a change in the excitability of receptors, and, consequently, the normalization of reflexes. All this will lead either to a decrease in the severity of the pain syndrome or the relief of it and contribute to the healing process’s speedy natural course.
Thus, it is currently difficult to determine the exact cause of the onset and effective frozen shoulder syndrome treatments. More research is needed to determine the causes, symptoms, and treatments for this condition.
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