What causes the shoulder to “freeze”?
The causes are not clear. It is believed that some scar tissue forms in the shoulder capsule. The capsule is a thin fabric that covers and protects the shoulder joint. Scar tissue can cause the capsule to thicken, contract, and limit shoulder movement. The reason this scar tissue forms is not known.
A frozen shoulder can occasionally occur after a shoulder injury (such as rotator cuff tendinopathy, dislocation, or repetitive trauma). However, this is unusual, and according to the medical literature, most cases occur for no apparent reason.
Will I need imaging exams?
Diagnosis of frozen shoulder is usually made by clinical and physical examination by a specialist physician. The doctor may also order an x-ray or an MRI of your shoulder joint4. The clinical diagnosis of idiopathic adhesive capsulitis depends on the detection of an overall decrease in the range of motion in the glenohumeral joint, absence of major previous trauma, and normal joint space on plain radiographs.
Magnetic resonance imaging assesses the rotator gap and axillary recess, which are sites commonly affected by adhesive capsulitis. MRI findings suggesting adhesive capsulitis include soft tissue thickening in the rotator gap, which may involve the coracohumeral and superior glenohumeral ligaments, and soft tissue thickening adjacent to the origin of the biceps.
What are the treatment options for frozen shoulder?
The goal of treatment is to relieve pain and stiffness, aiming to improve the patient’s functionality. One or more of the following options may be advised to help relieve and prevent symptoms.
- Acetaminophen or dipyrone may be advised to try to control pain.
- Codeine is a stronger opioid analgesic that can be used as an alternative to, or in addition to, acetaminophen. Constipation is a common side effect of codeine and other opioid medications such as tramadol.
It is important to remember that treatment is generally multifactorial, and it is probably necessary to combine a rehabilitation exercise program with common analgesics.
The anti-inflammatory analgesics that can be used are diverse, and include ibuprofen, diclofenac and naproxen. These medications work by helping to relieve pain as well as reducing any inflammation in your shoulder.
There are many different brands. So if one doesn’t fit, another might be fine. As a general rule, the use of anti-inflammatory drugs should be carried out for short periods, up to 5 days, due to their possible side effects.
Sometimes side effects occur with analgesics, anti-inflammatory drugs. Avoid using anti-inflammatory analgesic drugs, especially in the elderly, patients with kidney disease or with other comorbidities, as this class of drugs can increase the risk of stomach ulcers and kidney damage, among other possible adverse effects.