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Frozen Shoulder

Disease Details

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Description: Frozen shoulder, or adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint due to inflammation and thickening of the shoulder capsule.
Type: Frozen shoulder, or adhesive capsulitis, is not typically considered to have a genetic transmission. It is primarily associated with risk factors such as diabetes, thyroid disorders, prolonged immobility, and certain systemic conditions, rather than being inherited in a Mendelian genetic pattern.
Signs And Symptoms: Symptoms include shoulder pain and limited range of motion although these symptoms are common in many shoulder conditions. An important symptom of adhesive capsulitis is the severity of stiffness that often makes it nearly impossible to carry out simple arm movements. Pain due to frozen shoulder is usually dull or aching and may be worse at night and with any motion.The symptoms of primary frozen shoulder have been described as having three or four stages. Sometimes a prodromal stage is described that can be present up to three months prior to the shoulder freezing. During this stage people describe sharp pain at end ranges of motion, achy pain at rest, and sleep disturbances.

Stage one: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.
Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts from four to twelve months.
Stage three: The "thawing" or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.Physical exam findings include restricted range of motion in all planes of movement in both active and passive range of motion. This contrasts with conditions such as shoulder impingement syndrome or rotator cuff tendinitis in which the active range of motion is restricted but passive range of motion is normal. Some exam maneuvers of the shoulder may be impossible due to pain.
Prognosis: Most cases of adhesive capsulitis are self limiting, but may take 1 to 3 years to fully resolve. Pain and stiffness may not completely resolve in 20 to 50 per cent of affected people.
Onset: Frozen shoulder, or adhesive capsulitis, typically has an insidious onset, meaning it develops gradually over time without a specific injury initiating the condition. It commonly starts with mild pain and stiffness in the shoulder, which progressively worsens, leading to a significant reduction in the range of motion.
Prevalence: Frozen shoulder, also known as adhesive capsulitis, affects about 2% to 5% of the general population. It is more common in people aged 40 to 60 years and tends to occur more frequently in women than men.
Epidemiology: Adhesive capsulitis newly affects approximately 0.75% to 5.0% percent of people a year. Rates are higher in people with diabetes (10–46%). Following breast surgery, some known complications include loss of shoulder range of motion (ROM) and reduced functional mobility in the involved arm. Occurrence is rare in children and people under 40. with the highest prevalence between 40 and 70 years of age. The condition is more common in women than in men (70% of patients are women aged 40–60). People with diabetes, stroke, lung disease, rheumatoid arthritis, or heart disease are at a higher risk for frozen shoulder. Symptoms in people with diabetes may be more protracted than in the non-diabetic population.
Intractability: Frozen shoulder, also known as adhesive capsulitis, is generally not considered intractable. It often resolves on its own over time, but the recovery process can be lengthy, typically taking between one to three years. Treatment options such as physical therapy, steroids, and in some cases, surgical intervention can help speed up recovery and improve symptoms. While it can be challenging to manage, most people eventually regain full or near-full motion of the shoulder.
Disease Severity: Frozen shoulder, also known as adhesive capsulitis, typically progresses through three stages: the freezing stage, the frozen stage, and the thawing stage. The severity can vary:

1. **Freezing Stage**: This is the initial phase where pain gradually increases, and shoulder movements become restricted. This stage can last from six weeks to nine months.

2. **Frozen Stage**: During this phase, pain may begin to diminish, but the shoulder becomes stiffer. Range of motion is significantly reduced. This stage can last from four to six months.

3. **Thawing Stage**: Shoulder movement slowly improves, and pain continues to decrease. This stage can last from six months to two years.

Overall, the condition can result in significant pain and restriction of movement, greatly affecting daily activities. However, it usually resolves over time with or without treatment, although physical therapy and medical interventions can help expedite recovery and improve outcomes.
Healthcare Professionals: Disease Ontology ID - DOID:14188
Pathophysiology: The underlying pathophysiology is incompletely understood, but is generally accepted to have both inflammatory and fibrotic components. The hardening of the shoulder joint capsule is central to the disease process. This is the result of scar tissue (adhesions) around the joint capsule. There also may be a reduction in synovial fluid, which normally helps the shoulder joint, a ball and socket joint, move by lubricating the gap between the humerus and the socket in the shoulder blade. In the painful stage (stage I), there is evidence of inflammatory cytokines in the joint fluid.The main limiting factor in external rotation is due to the thickening of the coracohumeral ligament, which forms the roof of the rotator cuff and is a primary symptom of adhesive capsulitis. In addition, the coracohumeral ligament attributes to the limitation of internal rotation considering its connection to the supraspinatus and subscapular tendons. As the phases of adhesive capsulitis progress, the glenohumeral capsule begins to thicken and as a result the contraction of the capsule itself becomes the main reason as to why range of motion will be restricted in all planes of motion.
Carrier Status: Frozen shoulder, also known as adhesive capsulitis, does not have a carrier status since it is not a genetic or hereditary condition. It is a musculoskeletal disorder characterized by stiffness and pain in the shoulder joint. The exact cause is often unknown, but it is more common in people with certain risk factors such as age (40-60 years), diabetes, and immobility due to injury or surgery.
Mechanism: Frozen shoulder, also known as adhesive capsulitis, is characterized by stiffness and pain in the shoulder joint. The condition involves:

### Mechanism:
1. **Inflammation**: The initial phase involves inflammation of the synovial lining of the shoulder joint.
2. **Fibrosis**: Following inflammation, the joint capsule thickens and contracts due to the formation of fibrous tissue.
3. **Adhesion**: Adhesions develop between the joint capsule and the humeral head, restricting motion.

### Molecular Mechanisms:
1. **Cytokine Activity**: Key cytokines such as transforming growth factor-beta (TGF-β), interleukins (IL-1, IL-6), and tumor necrosis factor-alpha (TNF-α) are implicated in the inflammatory process.
2. **Fibroblast Activation**: Fibroblasts are activated and proliferated, leading to excessive collagen production and extracellular matrix remodeling.
3. **Matrix Metalloproteinases (MMPs)**: Altered expression of MMPs and tissue inhibitors of metalloproteinases (TIMPs) contribute to the pathological fibrosis.
4. **Myofibroblast Differentiation**: Myofibroblasts, which have contractile properties, are involved in the contraction of the joint capsule.
5. **Angiogenesis**: Increased vascular endothelial growth factor (VEGF) promotes new blood vessel formation within the synovium, often seen in the early inflammatory phases.

These molecular and cellular processes collectively contribute to the development and progression of frozen shoulder.
Treatment: There is consensus that non-surgical management is the initial treatment of choice for frozen shoulder. There is no strong evidence to favor any particular approach; in fact, some reviews suggest that multi-modal approaches combining several treatments are better. The effects of most treatments are primarily short-term, focusing on alleviating symptoms such as shoulder pain and reduced joint movement. Common treatments include exercise, physical therapy, oral analgesics such as paracetamol and NSAIDs, and intra-articular corticosteroid injections. Non-surgical treatment may continue for months, with more complex treatments such as ESWT, movement under analgesia, and hydrodilatation. It is unclear if these treatments lead to a quicker resolution of the disorder, or only manage chronic symptoms. The condition generally resolves itself with or without treatment. If conservative measures have no effect and the condition is long-lasting, or if evidence suggests surgical intervention, there are also several surgical procedures that may alleviate the disorder.
Compassionate Use Treatment: For frozen shoulder (adhesive capsulitis), off-label or experimental treatments may include:

1. **Capsaicin Cream**: Typically used for neuropathic pain, capsaicin cream may be used off-label to manage pain associated with frozen shoulder.

2. **Platelet-Rich Plasma (PRP) Injections**: Although primarily used for tendon injuries and osteoarthritis, PRP injections are being studied for their potential to enhance tissue repair in frozen shoulder.

3. **Hydrodilatation**: This procedure involves the injection of a large volume of saline, often mixed with corticosteroids, into the joint capsule to expand it and improve range of motion.

4. **Stem Cell Therapy**: Experimental stem cell treatments aim to reduce inflammation and promote healing, though more research is needed on their efficacy for frozen shoulder.

Since these treatments are off-label or experimental, they may not be widely available and should be discussed thoroughly with a healthcare professional for potential risks and benefits.
Lifestyle Recommendations: For frozen shoulder (adhesive capsulitis), lifestyle recommendations include:

1. **Exercise and Stretching:** Gentle stretching and range-of-motion exercises can help maintain mobility and reduce stiffness. It is important to follow a physical therapist's guidance to avoid overexertion.

2. **Heat Therapy:** Applying a warm compress or taking warm showers can help relax shoulder muscles and reduce pain before exercises.

3. **Ergonomics:** Adjust your work and home environment to avoid activities that exacerbate shoulder pain. For example, modify your computer workstation to keep your shoulder in a comfortable, neutral position.

4. **Pain Management:** Over-the-counter pain medications like ibuprofen or acetaminophen can help manage pain and inflammation. Always consult with a healthcare provider before starting any medication.

5. **Posture:** Maintain good posture, especially when sitting or standing for extended periods, to avoid putting additional strain on the shoulder.

6. **Cold Therapy:** Use ice packs on the shoulder to help reduce inflammation and numb the area, especially after exercises.

7. **Avoid Immobilization:** While resting the shoulder is important, complete immobilization can worsen the condition. Balance rest with gentle movements.

8. **Regular Check-ups:** Regularly visit your healthcare provider or physical therapist to monitor progress and adjust your treatment plan as necessary.

Adhering to these lifestyle recommendations can aid in the improvement of shoulder mobility and the reduction of symptoms associated with frozen shoulder.
Medication: Medications such as NSAIDs can be used for pain control. Oral steroids may provide short-term benefits in range of movement and pain but have side effects such as hyperglycemia. Corticosteroids may also be used by local injection. In the short and medium term, intra-articular corticosteroid injections appear most effective in pain alleviation and increase in range of motion, although the injection does carry complications. Unfortunately, the effects of medication are not long-lasting. Oral corticosteroids in particular should not be used consistently to treat adhesive capsulitis, because of the dangers associated with long-term use and the lack of long-term benefit.
Repurposable Drugs: Frozen shoulder, also known as adhesive capsulitis, can sometimes be managed with repurposed drugs that are typically used for other conditions. Although there is no definitive cure through repurposed drugs, certain medications may help alleviate symptoms:

1. **Corticosteroids**: These are commonly used to reduce inflammation and pain, and can be administered orally or via injection.
2. **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)**: Drugs like ibuprofen and naproxen can help reduce pain and inflammation.
3. **Gabapentin or Pregabalin**: Originally used for neuropathic pain, these drugs may help manage pain associated with frozen shoulder.
4. **Nifedipine**: Typically used for hypertension, this calcium channel blocker has some evidence suggesting it might improve shoulder mobility.

Always consult a healthcare provider for appropriate diagnosis and treatment options tailored to individual needs.
Metabolites: Frozen shoulder, also known as adhesive capsulitis, is characterized by stiffness and pain in the shoulder joint. **Metabolites** associated with this condition are not well-documented, as the primary focus of research is often on inflammatory mediators and fibrosis-related factors rather than specific metabolic byproducts. Treatment typically involves physical therapy, anti-inflammatory medications, and in some cases, corticosteroid injections or surgery.

There is no recognized link between frozen shoulder and **nanotechnology-based** treatments at this time. Current research and therapeutic approaches do not commonly involve nanotechnology.
Nutraceuticals: Nutraceuticals, such as Omega-3 fatty acids, turmeric (curcumin), and glucosamine, are often considered for their potential anti-inflammatory and joint-supporting properties, which could benefit individuals with frozen shoulder (adhesive capsulitis). However, scientific evidence supporting the effectiveness of these supplements for frozen shoulder specifically is limited. Always consult a healthcare professional before starting any new supplement regimen.
Peptides: Frozen shoulder, or adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. Regarding peptides, there isn't a well-established treatment involving peptides specifically for frozen shoulder. Treatment typically involves physical therapy, pain management (including NSAIDs or corticosteroid injections), and sometimes surgical intervention if conservative methods fail.