Adhesive capsulitis, or in other words frozen shoulder syndrome, is a disease that causes the soft tissues of the shoulder joint and the joint capsule to harden for an unknown reason and cause difficulty in movement. It is seen in 5% of the general population and is more common in women between the ages of 40-60.
The cause of frozen shoulder syndrome is not fully known. In the initial stages, an inflammatory reaction develops and the shoulder joint swells, creating edema. Later, this fluid freezes and creates stiffness in the capsule surrounding the shoulder joint and the intra-shoulder ligaments.
Frozen shoulder syndrome may also occur after previous trauma or surgery. Secondary frozen shoulder to these. It is called syndrome. Its pathology is the same as primary frozen shoulder syndrome, which occurs without an unknown cause.
Previous presence of frozen shoulder syndrome in the opposite shoulder, endocrine system diseases such as diabetes and thyroid, cardiovascular system diseases, stroke, and neurological diseases such as Parkinson's are risk factors for frozen shoulder syndrome.
The first stage of frozen shoulder disease is the edema stage. It is the first 2.5 -3 month period. There is pain, more at night. Since the hardening in the joint capsule is still minimal, there is movement up to a certain level when the shoulder is moved passively.
The second phase is the freezing phase. It is a period of 3 months - 1 year. Movement is restricted. Since the inflammation phase is over, there is no inflammation-like pain, but there is severe pain at the time of movement due to freezing.
The third phase is the thaw and relaxation phase. It is a period of 1 year to 3 years. A gradual spontaneous improvement is observed in shoulder movements and functions.
The diagnosis of frozen shoulder syndrome can be made mainly by physical examination. Observation of thickening and narrowing in the capsule with MRI examination can help in diagnosis. Other pathologies and decrease in bone density that may occur due to disease can be detected with X-ray.
In frozen shoulder syndrome, non-surgical treatment is preferred first. Oral anti-inflammatory drugs may be more effective in controlling pain rather than treating the disease. Similarly, using oral cortisone in the first stage of the disease may reduce short-term pain relief. It is effective in controlling and providing range of motion.
Cortisone injections into the joint are a highly effective application when combined with physical therapy. However, the injection must be made completely into the capsule. Not every cortisone application to the shoulder may provide the same benefit in terms of the anatomical target point.
Surgical treatment is applied to patients who do not improve in pain and range of motion despite 6 months of treatment. Adhesions in the shoulder are removed by arthroscopic, that is, closed methods. It is cleaned and the joint capsule is cut and loosened. Open surgery is preferred very rarely and only in cases of frozen shoulder syndrome secondary to severe trauma.
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