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Frozen Shoulder

  • Frozen shoulder

Frozen shoulder is a condition that causes a great deal of discomfort and nuisance to many everyday activities. This condition is also known as adhesive capsulitis, and the condition usually follows a pattern of pain and movement restriction that hangs around for many months. Frozen shoulder is most common in the over 40 age group and has a prevalence of between 2-5% in the general population (1).

Sometimes a frozen shoulder develops after an injury, such as a fall onto the shoulder or a severe jarring force to the joint. However, for most people, the condition seems to come out of the blue. The first stages of a frozen shoulder are typically pretty painful with not too much joint stiffness. Sleep is often very disturbed and during this stage it is important to get medical advice and appropriate analgesic medication. The second phase of a frozen shoulder typically features a gradual reduction in pain and an increased amount of joint stiffness. The final stage sees the shoulder being primarily stiff with not too much pain.

There is a growing amount of evidence that points to an underlying metabolic cause for a frozen shoulder. This are links between frozen shoulder, diabetes, obesity and some heart & lung conditions. These conditions are linked to metabolic syndrome. This is a group of biological changes including lipid abnormalities, elevated blood insulin levels. Associated with this is an immune response, which includes an increase of pro-inflammatory cytokines. These substances cause a chronic low grade inflammatory state (2). Low grade inflammation
is thought to be the thing that causes a frozen shoulder because it causes the shoulder soft tissues to become contracted band sensitive to movement.

The important thing to remember about frozen shoulder is that it is a self limiting condition. This means that it will resolve naturally over time. There are a number of things that can help this process along and a number of things that can make things worse. The best advice is get medical help, particularly in the early stages so that good pain management can be established. Then some occasional visits to a Physiotherapist are a good idea so that the course of the condition can be monitored and appropriate mobilising and strengthening work can be administered to restore full shoulder function.

References
1 Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol 1975; 4:193.
2 Hutcheson R, Rocic P. The metabolic syndrome, oxidative stress, environment, and cardiovascular disease: the great exploration. Exp Diabetes Res 2012;2012:1–13.

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