Frozen shoulder , or capsulitis , is a condition affecting the shoulder joint , characterized by pain and stiffness. Symptoms can vary depending on the progression of the disease (capsulitis can be divided into three stages) and can be quite disabling for the patient. Early intervention is essential for establishing the right treatment.
Dr. Marco Neri , orthopedic surgeon at Humanitas San Pio X and the Humanitas Medical Care clinic in Murat , talks to us about it .
What are the stages of frozen shoulder?
As we were saying, frozen shoulder can be divided into three phases:
- Capsulitis phase : This generally lasts 6-12 weeks and is the initial and most painful phase of the disease; the pain worsens over time, increasingly limiting the use of the shoulder (while the joint still retains much of its mobility, which however will gradually lose).
- Freezing phase : can last 4-6 months, and is characterized by a decrease in pain and an increase in joint stiffness
- Thawing phase : this can last more than a year and sees a gradual improvement in the patient’s condition.
What causes frozen shoulder?
Capsulitis tends to occur especially in the dominant shoulder (the one with the greatest strength) and only 10% of cases affects both joints. The main risk factors for capsulitis are:
- age (usually occurs in patients between 40 and 60 years of age)
- sex (mainly affects women)
- diabetes
- thyroid dysfunction
- arthritis
- Parkinson’s disease
- cardiovascular diseases
- previous shoulder injury
- side effects of some drugs
- hypercholesterolemia
How is frozen shoulder diagnosed?
The diagnosis can be confirmed by a specialist examination and specific tests. Further diagnostic tests may also be necessary, such as x-rays to ensure there are no local bone lesions or signs of osteoarthritis, or non-contrast MRI to evaluate other types of pathologies, such as rotator cuff tears, calcifications, and loose bodies.
Other tests, such as blood tests, may be performed to evaluate the presence of predisposing diseases such as hypercholesterolemia, diabetes, and thyroid dysfunction.
How is frozen shoulder treated?
The main objectives of the treatment of painful shoulder are to reduce pain and regain lost mobility:
To treat frozen shoulder, a conservative treatment can be performed initially with a therapy based on cortisone combined with painkillers (in extreme cases one or more infiltrations with hyaluronic acid and anesthetic can be performed), to reduce the severe pain in the initial stages ; stretching and mobilization exercises (always to be performed within the pain threshold), to improve the range of motion of the shoulder and minimize the loss of muscle tone ; the magnetic field ( bemer ) ; tecar therapy , especially for painful contractures around the shoulder blade ; moist heat (such as compresses, shower or bath), used especially in the initial phase and above all during the freezing and thawing phases.
When is shoulder surgery necessary?
When conservative treatment has failed to resolve either the pain or the movement. In this case, arthroscopic shoulder capsular lysis surgery is performed, which allows for the identification and treatment of additional pathologies, such as impingement lesions of the subacromial space (such as subacromial calcifications, acromioclavicular osteoarthritis, rotator cuff tears, and lesions of the long head of the biceps brachii).
The patient is discharged 24 hours after surgery with postoperative medication and the prescription of some rehabilitation exercises to be performed periodically, as prescribed by the physiotherapist. The suture will be removed 12-14 days after surgery, and the patient will undergo periodic outpatient checkups.
