Shoulder pain ranks among the top causes of pain and disability leading to work absenteeism. Frozen shoulder, also known as adhesive capsulitis, presents a challenging condition characterised by prolonged stiffness and pain in the shoulder joint. Statistics indicate that frozen shoulder affects approximately 2 - 5% of the general population, with a higher prevalence among individuals aged 40 - 60 years (Mezian, 2023).
This review delves into the multifaceted aspects of frozen shoulder, incorporating insights from recent scientific studies to provide a thorough understanding of the condition.
Pathophysiology of Frozen Shoulder: Unravelling the Intricacies
Frozen shoulder manifests because of the thickening and contracture of the glenohumeral joint capsule, leading to a progressive restriction in range of motion and persistent pain. Recent research sheds light on the inflammatory pathways implicated in the pathogenesis of frozen shoulder, highlighting the role of cytokines and immune responses in driving the adhesive capsulitis process. This inflammatory cascade contributes significantly to the development and progression of the condition, emphasising the need for targeted interventions.
The symptoms of frozen shoulder, also known as adhesive capsulitis, typically progress through three distinct stages (Miftari and Lahu, 2019).
1. Freezing Stage: During this initial stage, individuals may experience a gradual buildup of severe pain in the shoulder joint, especially when attempting to move the joint. Finding a comfortable position, particularly during sleep, becomes challenging. This stage is often divided into two parts: the first part characterised by severe pain, followed by stiffness in the shoulder joint as the joint covering adheres to the bones.
2. Frozen Stage: In the subsequent stage, the intensity of pain may diminish, but stiffness persists. Individuals may find it increasingly difficult to lift the shoulder and move the arm backward, known as external rotation of the shoulder joint.
3. Thawing Stage: As the condition begins to resolve, stiffness in the shoulder joint gradually improves. Without treatment, it may take anywhere from 1 to 3 years for the condition to progress to the thawing stage.
These stages of frozen shoulder typically manifest gradually, with symptoms worsening over time before gradually improving. Understanding these stages is crucial for timely diagnosis and appropriate management of this painful and restrictive condition.
Genetic Predisposition: Unveiling Hidden Factors
It has been shown though studies of genome-wide associations that there is a genetic predisposition to frozen shoulder (Navarro-Ledesma et al., 2024, Kulm et al., 2022). Several other risk factors have been identified that predispose individuals to developing frozen shoulder such as: diabetes mellitus, thyroid disorders (hyper- or hypothyroidism), metabolic syndrome, female gender. Additionally, secondary frozen shoulder can occur following injuries, such as calcific tendinosis, rotator cuff or bicep tendinopathy, stroke, or other diseases like cancer or Parkinson's disease (Mezian, 2023).
Management Strategies and Comparative Effectiveness: Navigating Treatment Options
While various treatment modalities exist for frozen shoulder, the optimal approach remains a subject of debate (Rusanov and Vitomskyi, 2022). The effectiveness of different physical therapy mobilisations in managing frozen shoulder has been well researched and analysis revealed improvements in pain, range of motion, and quality of life with specific physiotherapy techniques (Rahbar et al., 2022).
Physiotherapy has been shown to play a crucial role in improving the quality of life of individuals with frozen shoulder (Miftari and Lahu, 2019). A comprehensive physiotherapy assessment helps identify the affected structures and guide the development of an individualised treatment plan. Physiotherapy techniques, such as exercise, manual therapy, and massage, have been demonstrated to positively impact pain, range of motion, and quality of life in patients with frozen shoulder (Rusanov et al., 2023). It is important that an individually tailored rehabilitation programme is created for patients by physiotherapists to enhance a successful outcome.
Statistics and Clinical Implications: Empowering Evidence-Based Practice
Understanding the risk factors, pathophysiology, and treatment options for frozen shoulder is crucial in guiding clinical practice and improving patient care outcomes. This synthesis of recent scientific findings provides a perspective on frozen shoulder, highlighting the intricate interplay of genetic, inflammatory, and other risk factors in the pathophysiology of the condition.
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References.
The creation, enrichment, and editing of this article for enhanced clarity was facilitated by the use of Perplexity Ai rewrite https://www.perplexity.ai (accessed 13th May 2024)
References
Frozen Shoulder Physiopedia. Available at: https://www.physio-pedia.com/Frozen_Shoulder (Accessed: 16 April 2024).
Mezian, K. (2023) Frozen Shoulder, StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482162/ (Accessed: 18 April 2024).
KULM, S., LANGHANS, M. T., SHEN, T. S., KOLIN, D. A., ELEMENTO, O. & RODEO, S. A. 2022. Genome-Wide Association Study of Adhesive Capsulitis Suggests Significant Genetic Risk Factors. Journal of Bone & Joint Surgery, American Volume, 104, 1869-1876.
MIFTARI, S. & LAHU, N. 2019. THE ROLE OF PHYSIOTHERAPY IN TREATMENT OF FROZEN SHOULDER. Research in Physical Education, Sport & Health, 8, 105-111.
NAVARRO-LEDESMA, S., HAMED-HAMED, D. & PRUIMBOOM, L. 2024. A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system. Frontiers in Physiology, 15.
RAHBAR, M., RANJBAR KIYAKALAYEH, S., MIRZAJANI, R., EFTEKHARSADAT, B. & DOLATKHAH, N. 2022. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial. Clinical Rehabilitation, 36, 669-682.
RUSANOV, A. & VITOMSKYI, V. 2022. Physical Therapy in the Treatment of Adhesive Capsulitis of the Shoulder Joint. Ukraïnsʹkij žurnal medicini, bìologìï ta sportu, 7, 31-37.
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