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Frozen shoulder

Frozen shoulder or adhesive capsulitis is a medical condition in which the movement of shoulder joint becomes painful and restricted. Although the exact underlying cause is unknown, in frozen shoulder the capsule surrounding the shoulder joint (glenohumeral joint) becomes inflamed resulting into stiffening of the affected shoulder joint with restricted movement.
This condition is extremely painful; there are certain factors which tend to aggravate the pain. These conditions include night time, exposure to cold, certain type of movement of the shoulder joint etc. Injury and trauma to the shoulder joint is thought to be one of factors leading to frozen shoulder however autoimmune diseases might play an important role in causing the disease.
Frozen shoulder may lead to severe degree of pain which interrupts night time sleep frequently. Frozen shoulder in most of the people resolves on its own with time without any surgical manipulation of the affected joint. In about 90% of the affected person there is regaining of shoulder movement to some extent.
The symptoms of frozen shoulder usually develop very slowly over years. The symptoms are categorized under three stages; these are
1. Painful stage: in this stage all type of shoulder movement becomes very much painful with grossly limited range of movement of the affected shoulder joint.
2. Frozen stage: in this stage pain decreases considerably however stiffness of the affected joint increases to a severe extent.
3. Thawing stage: in this stage the symptoms of frozen shoulder starts relieving including pain and stiffness.
Like any other joints of the body, the bones, ligaments (cord like structures which held the adjacent bones forming a joint together) and tendons (the end cord like narrow part of the muscle which attaches the muscle to respective bones)of the shoulder joint are protected frictional injury by a capsule (special type of connective tissue ). In frozen shoulder this capsule becomes thick over time and leads to severe degree of stiffness and pain in the affected joint.
Although the exact underlying cause responsible for the said change in the capsule of the shoulder joint is not known there are several hyporthesis like immobilization for prolonged period of time as in women who have undergone recent surgery, especially breast surgery etc.
Risk factors
Common risk factors for frozen shoulder include
1. Progressive age: people above 40 years of age are at increased risk of suffering from frozen shoulder.
2. Being women
3. Immobility or decreased movement of the shoulder joint for several days. Common conditions leading to restricted movements of the shoulder joints include injury to the shoulder muscles (rotator calf muscles), stroke, fractured arm etc.
4. Suffering from certain medical conditions may increase the chance of suffering from frozen shoulder also; these diseases are
    a. Diabetes mellitus
    b. Cardiac diseases
    c. Tuberculosis infection
    d. Inadequate functioning of the thyroid gland as characterized by increased (hyper-) or decreased (hypo-) secretion of thyroid hormones.
    e. Parkinson’s diseases
     f. Other neurodegenerative diseases
The aim of treatment of frozen shoulder is to relieve pain and improve the shoulder movement. Treatment options include
Drugs: drugs include aspirin and other NSAIDS given to reduce pain and inflammation of the capsule
Physical therapy: it includes stretching exercise which gradually improves the range of mobility of the affected joint.
Surgical intervention: in most of the cases of frozen shoulder the symptoms usually resolve by 12 to 18 months without any intervention; however in cases with persistent symptoms surgical intervention is required. Options include
1. Injection of steroid directly in the affected joint (intraactrticul;ar) as it helps in reducing the  inflammatory changes of the joint
2. Injection of water may help in relieving the bothersome symptoms by stretching the joint capsule and physically improve joint mobility
3. Surgical manipulation: in this procedure the affected joint is manipulated (moved in different direction) so that movement of the joint improves. General anesthesia is used so that the patient does not feel any pain.
4. Surgery: this is the last resort. In this procedure the surgeon using a scope fitted with light (arthroscope) removes the scar tissue and adhesions surrounding the shoulder joint through a small cut made on the affected joint.

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