Reviewarticle biological aspect of pathophysiology for frozen shoulder chulhyuncho,1 kwangsoonsong,1 beomsookim,1 duhwankim,2 andyunmeelho3 painresearchcenter,departmentoforthopedicsurgery,dongsanmedicalcenter,schoolofmedicine,keimyunguniversity. It affects 2%5% in the general population 1,2, with more prevalence in women between the ages of 40 and 60 years 3, 4,5. A frozen shoulder adhesive capsulitis is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Adhesive capsulitis and frozen shoulder syndrome fss are two terms that have been used to describe a painful and stiff shoulder. The pathology of frozen shoulder includes a chronic in.
When this joint becomes inflamed, as happens with frozen shoulder, it becomes painful to move your shoulder. It usually involves pain and stiffness that develops gradually, gets worse and then finally goes away. In many cases, there is less synovial fluid in the joint. Frozen shoulder adhesive capsulitis orthoinfo aaos.
Jul 20, 2015 the shoulder, or glenohumeral joint, is made up of a capsule filled with ligaments that attach the shoulder bones together. The etiology of frozen shoulder is not yet fully understood. Despite its common occurrence, there is a significant knowledge void concerning. Decrease in joint volume as a result of fibrosis and hyperplasia of the. The current consensus definition of a frozen shoulder by the. Some injuries aggravate the muscles and tendons surrounding the shoulder and straining or overuse of these muscles make the shoulder sore. Biological aspect of pathophysiology for frozen shoulder hindawi. Information on this topic is also available as an orthoinfo basics pdf handout. Investigation of the intraarticular and periarticular pathology would contribute to the treatment of primary fs. Primary frozen shoulder fs is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. The term frozen shoulder has been loosely applied to conditions when the shoulder is working at less than its optimal range. However, some plausible risk factors have been identified.
In examining the pathology and pathophysiology of adhesive capsulitis, we found recent evidence that intraarticular use of hyaluronan can provide effective relief. Adhesive capsulitis ac, often referred to as frozen shoulder is characterized by initially painful and later progressively restricted active and passive. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the. Aug 15, 2016 histological studies were inconclusive but suggested that immune, inflammatory and fibrotic changes where associated with primary frozen shoulder.
There is loss of both passive and active range of motion and shoulder movement is extremely painful. Reviewarticle biological aspect of pathophysiology for. Mar 17, 2020 a frozen shoulder adhesive capsulitis is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is associated with substantial and protracted morbidity. Patients with diabetes mellitus are at greater risk of developing frozen shoulder, with a prevalence of 10 to 20 percent. It usually involves pain and stiffness that develops gradually, gets worse and then. To understand frozen shoulder or adhesive capsulitisa condition that limits the shoulders range of motionits important to understand the anatomy of the joint. Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Jul 20, 2018 frozen shoulder occurs when the connective tissue enclosing the joint becomes thickened and tight. Frozen shoulder, is commonly encountered in orthopedic practice. Recent history of traumatic shoulder injury, prior surgery to affected shoulder, diabetes mellitus, thyroid disease, and previous history of adhesive capsulitis are all risk factors for developing adhesive capsulitis. Sep 18, 2018 adhesive capsulitis and frozen shoulder syndrome fss are two terms that have been used to describe a painful and stiff shoulder.
Typically the joint is stiff and initially painful, often starting without an apparent cause. Learn what to expect while you recover and whether or not you can still exercise. For this reason, management of frozen shoulder remains controversial. In frozen shoulder, the shoulder capsule becomes tight and stiff. Frozen shoulder adhesive capsulitis brett sanders, md center for sports medicine and orthopaedic 2415 mccallie ave. Frozen shoulder occurs when the connective tissue enclosing the joint becomes thickened and tight. It is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and fibrosis to. It becomes painful and more difficult to move your shoulder.
Adhesive capsulitis ac, often referred to as frozen shoulder is characterized by initially painful and later progressively restricted active and passive glenohumeral joint range of motion with spontaneous complete or nearcomplete recovery over a varied period of time. Pdf it is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and. The main pathology of frozen shoulder used to be considered as fibrosis and inflammation. Understanding the pathology associated with this condition may help to improve management.
Adhesive capsulitis, commonly described as frozen shoulder, is experienced as chronic soreness and discomfort accompanied by an. Mar 01, 2019 adhesive capsulitis, also known as frozen shoulder, is a common condition of the shoulder defined as a pathologic process in which contracture of the glenohumeral capsule is a hallmark. Aug 31, 2018 adhesive capsulitis, most commonly referred to as frozen shoulder fs, is an idiopathic disease with 2 principal characteristics. Department of physiotherapy, faculty of pharmacy and health sciences, universiti kualalumpur royal college of medicine perak, malaysia. Its also known as impingement syndrome or swimmers shoulder, since its common in swimmers. The term frozen shoulder fs is used to describe a clinical condition with restricted active and passive range of motion in all directions, both flexion, abduction and. Shoulder impingement is a common source of shoulder pain. Always warm up your shoulder before performing your frozen shoulder exercises. Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder.
It is a condition that typically affects middleaged women, with some evidence for an association with endocrinological, rheumatological, and autoimmune disease states. Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is. Frozen shoulder syndrome is a condition in which a soft tissue glenohumeral capsular lesion is accompanied by painful and restricted active and passive shoulder motion. Frozen shoulder is a very common condition with a prevalence of 2%5% in the general population. The pathophysiology of fs is relatively well understood as a pathological process. Our recent study has demonstrated that chondrogenesis is also characteristic to idiopathic frozen shoulders. Frozen shoulder etiology, pathogenesis and natural course.
Although articles for the pathophysiology of frozen shoulder provide inconsistent and inconclusive results, they have suggested both inflammation and fibrosis mediated by cytokines, growth factors. Review article physiotherapy interventions for adhesive. Frozen shoulder, which is also called adhesive capsulitis, causes pain and stiffness in your shoulder. Frozen shoulder contracture syndrome aetiology, diagnosis. Frozen shoulder exercises are usually the cornerstone of treating frozen shoulder.
Pathology stages adhesive capsulitis frozen shoulder. Pdf biological aspect of pathophysiology for frozen shoulder. Injuries to the shoulder are very common, especially in people who are active in sports. The pain and stiffness can impact daily life activities but tend to improve over time. Adhesive capsulitis symptoms, diagnosis and treatment. Despite its common occurrence, there is a significant knowledge void concerning frozen shoulder syndrome and its treatment. Chattanooga, tn 423 6242696 if youre having trouble lifting your arm above your head, reaching across your body or behind your back, and have limited motion in your shoulder, it may be an early symptom of frozen shoulder. Frozen shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable stiff. Jan 02, 2018 shoulder impingement is a common cause of shoulder pain. A few factors may put you more at risk for developing frozen shoulder.
The hallmark sign of frozen shoulder, also known as adhesive capsulitis, is. Histological studies were inconclusive but suggested that immune, inflammatory and fibrotic changes where associated with primary frozen shoulder. Frozen shoulder is reported to affect 25% of the population. The current consensus definition of a frozen shoulder by the american shoulder and elbow surgeons is a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder. It is usually a result of the inflammation, scarring, tightening of the connective. In this letter, we summarized this research to obtain a better understanding of the pathophysiology of adhesive capsulitis and the effects of hyaluronan. Frozen shoulder can be primary or idiopathic but is often associated with other diseases and conditions. Over time, the shoulder capsule thickens and stiff bands of tissuecalled adhesionsdevelop. Pathophysiology of adhesive capsulitis of shoulder and the. Adhesive capsulitis, commonly referred to as frozen shoulder, is a debilitating condition characterized by progressive pain and limited range of motion about the glenohumeral joint.
Frozen shoulder is a condition that affects your shoulder joint. What is frozen shoulder syndrome fss adhesive capsulitis. It is one of the most painful conditions of the shoulder the others being calcific tendonitis or referred nerve pain from the neck. The joint capsule contains the ligaments that attach the. Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint called the shoulder joint capsule become thick, stiff, and inflamed. Frozen shoulder fs is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. Dec 04, 20 primary frozen shoulder fs is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Orthoinfo basics frozen shoulder to help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and joint. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular. Adhesive capsulitis, most commonly referred to as frozen shoulder fs, is an idiopathic disease with 2 principal characteristics. The shoulder, or glenohumeral joint, is made up of a capsule filled with ligaments that attach the shoulder bones together. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.
After a period of worsening symptoms, frozen shoulder tends to get better, although full recovery may take up to 3 years. The pathophysiology associated with primary idiopathic. Primary frozen shoulder is a common, severely debilitating condition with a prevalence of between 2% and 5%. The pathophysiology associated with primary idiopathic frozen shoulder. Determining the pathophysiological processesof frozenshoulder is a pivotalmilestone in thedevelopmentofnoveltreatment for patients withfrozen shoulder. Adhesive capsulitis in physical medicine and rehabilitation. Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited.
The diabetic connection written by ronald grisanti, d. Frozen shoulder symptoms, causes, diagnosis, treatment. When this joint becomes inflamed, as happens with frozen shoulder, it becomes. The causes of frozen shoulder are not fully understood. Physical therapists in a variety of settings treat individuals with frozen shoulder syndrome. Research article open access the pathophysiology associated with primary idiopathic frozen shoulder. Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffnes.
The cell density was significantly higher and the capsular tissue was significantly stiffer in frozen shoulders compared with shoulders with. It affects 2%5% in the general population 1,2, with more prevalence in women between the. Adhesive capsulitis, also known as frozen shoulder, is a condition associated with shoulder joint pain and stiffness. Pain shoulder pain associated with fs is progressive and initially felt mostly at night or when the shoulder is moved close to the end of its range of motion rom.
For this reason, managementof frozen shoulder remains controversial. Reviewarticle biological aspect of pathophysiology for frozen. The term frozen shoulder fs is used to describe a clinical condition with restricted active and passive range of motion in all directions, both flexion, abduction and rotation. Recent history of traumatic shoulder injury, prior surgery to affected shoulder, diabetes mellitus, thyroid disease, and previous history of adhesive capsulitis. Frozen shoulder also known as adhesive capsulitis is a condition in which the shoulder is stiff, painful, and has limited motion in all directions.