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Frozen Shoulder or adhesive capsulitis

Frozen shoulder is an inflammation in the lining (capsule) of the shoulder joint. The exact relationship between frozen shoulder and Dupuytren’s disease is not known, but patients with one condition have a higher risk of developing the other. Dupuytren’s patients have an 8 times higher chance of getting a frozen shoulder, and 18-50% of frozen shoulder patients have or develop Dupuytren’s disease as well. Dupuytren’s-like nodules and calcium deposits have been found in tissues around the shoulder (on tendons or the joint capsule)

Frozen shoulders can last anything from 6 weeks to 2 or more years. They are seen more in women age 40-60. An estimated 2-5% of the population will get some degree of frozen shoulder. Usually only one shoulder is affected. It is more common in people with a history of Dupuytren’s disease, Diabetes Mellitus, overactive thyroid and Parkinson’s. Phenobarbitone and phenytoin (epilepsy medications) are also said to increase the incidence of frozen shoulders.

In a frozen shoulder the shoulder joint capsule becomes inflamed and scar tissue forms in the capsule ( adhesive capsulitis), thus thickening it and making it less flexible, and reducing the nutrition to the joint.

In 1934 Codman laid down 12 diagnostic criteria , the main four are:

1)  the condition comes on slowly
2) pain is felt near the insertion of the Deltoid muscle ( on top of the shoulder front and back)
3)  inability to sleep on the affected side painful and
4) incomplete external rotation (active and passive,  <50% of the normal side at passive manipulation, pathognomonic)

There are three phases to the condition:

1) the freezing phase where the shoulder becomes increasingly more painful and less mobile.
2) the frozen phase where the pain is less but movements are very limited.
3) the thawing or recovery phase where slowly the range of movement increases again. The whole process can take 2-3 years, sometimes more.

 

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