Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is a painful restriction of shoulder movement resulting from inflammation and thickening of the capsule surrounding the shoulder joint. It is more common in women aged 40-60. Diabetes, thyroid disease, and prolonged immobilization are risk factors. The condition progresses in three typical phases: painful phase, freezing phase, and thawing phase.

Symptoms

There are three distinct clinical phases:

• Painful phase (2-9 months): Gradually starting, nocturnally worsening deep shoulder pain
• Freezing phase (4-12 months): Pain decreases but motion restriction becomes pronounced; combing hair, scratching back become impossible
• Thawing phase (5-24 months): Movement gradually returns to normal
• Both active and passive movements are restricted
• External rotation and abduction (lifting arm) most affected

Diagnostic Methods

Diagnosis is largely made clinically. The characteristic finding is restriction of both active (patient-performed) and passive (examiner-performed) motion. X-rays are usually normal; they are obtained not for diagnosis but to exclude arthritis or other pathology. MRI is needed when concomitant pathologies (rotator cuff tear, etc.) are suspected.

Treatment Approach

Non-Surgical Treatments

The vast majority heals without surgery. Treatment is multimodal: active physical therapy (stretching and motion-expanding exercises), NSAIDs, nighttime heat application, intra-articular cortisone injection is very helpful in the pain phase. For more resistant cases, hydrodistension (joint distention with high-volume fluid) can be performed. The mainstay of treatment is regular physical therapy.

Surgical Treatment

Surgery is an option for cases unresponsive to 6-12 months of conservative treatment and seriously affecting function. Two methods exist: manipulation under anesthesia (forced movement under general anesthesia to break adhesions) and arthroscopic capsular release (camera-guided release of the tightened capsule). Arthroscopy is generally preferred in diabetic patients.

Surgical Process

Performed under general anesthesia. In arthroscopic release, 3-4 small portals are used, and tightened capsule portions are controlled-released. Procedure takes 30-45 minutes.

Hospital Stay

Usually same-day or 1 overnight. Starting active movement immediately after surgery is critical.

Recovery Process

• First 48 hours: Pain control, start of passive range exercises
• Weeks 1-2: Active physical therapy (3-5 sessions/week)
• Weeks 2-6: Maintaining range of motion, home exercises
• Months 2-3: Strengthening exercises
• Months 3-6: Return to full function

Return to Work

Return to desk work in 1-2 weeks, physical work in 4-8 weeks. Physical therapy must continue in parallel.

Potential Complications

The most important risk after surgery is re-stiffening due to inadequate physical therapy participation. Recurrence rates in diabetic patients are 2-3 times higher than in others. Rare complications include bone fracture (especially in osteoporotic patients during manipulation) and nerve injury.