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How to recognize a frozen shoulder?

We can compare the work of the shoulder joint to a crane. Think of the cables of this crane as the nerves, the motor muscles, its point of support as the shoulder joint, and the shoulder and arm as the lever arms of the crane. If there is a break in the cable of this crane or a malfunction in the engine, it cannot be activated for different reasons. In the shoulder joint, if there is an interruption in the cable, that is, the incoming electricity, someone else can hold the arm and move the shoulder joint. This is called passive movement. But if there is a disorder in the muscles or the joint itself, you cannot move the arm passively. Here it is not possible to do passive movements on the stiff shoulder.



What are the complaints of frozen shoulder?


Pain from the frozen shoulder is often dull and severe. It is usually very bad early in the disease and increases when trying to move your arm. Pain is usually located on the outer shoulder area and sometimes on the upper arm. It can be enough to cause pain at night. Movements are severely restricted and the restriction increases over time. This limitation increases within months, and as the restriction increases, resting pain may decrease.




In which diseases is stiff shoulder more common?


Neurological diseases

Thyroid patients

Diabetes patients

Cancer patients

Kidney patients


Parkinson's patients

Dupuytren's patients

Some genetic diseases


It is usually noticed late during rehabilitation in patients with frozen shoulder stroke (cerebrovascular disease). The frozen shoulder may not be noticed, as it is known that there is immobility in the patient's arm already affected by stroke.


In the frozen shoulder, the shoulder capsule (the cover that surrounds the joint) thickens and becomes hard and firm. Thick bands of tissue called adhesions develop. In most cases there is a poorer quality synovial fluid in the joint.


What are the development stages of the disease?


Stage 1: The onset of freezing

During the "freezing" phase, an increasing pain is felt in the shoulder. As the pain worsens, your shoulder loses range of motion. The freezing process takes between 6 weeks and 9 months.


2nd stage: Freezing period

Now the hardness is too high, the pain is reduced.

 It is very difficult to do daily tasks at this stage, which can take 4 to 6 months. Some patients, especially some frozen shoulders developed with neurological diseases, cannot go beyond this stage.


Stage 3: Thawing

Shoulder movement begins to "unwind" slowly. Full return to normal or normal strength or movement close to the other shoulder can take from 6 months to 3 years.

This disease can usually heal spontaneously, albeit laboriously, for a long time. However, it is not easy for a person to live disabled and unhappy for 3 years and it will be an unnecessary and serious waste of time.



What is done in the examination?

After discussing your complaints and medical history at the exam, we carefully move your shoulder in all directions to see if movement is limited and there is pain with movement. This range of motion is called "passive range of motion" when someone else moves your shoulder while you have fully released the arm. Your doctor will compare this to the range of motion you show when you move your shoulder by yourself ("active range of motion"). People with frozen shoulders have limited movements, both active and passive.

X-rays are taken to understand the health of the bone and joint space.

MRI is ordered for problems in soft tissues and muscle tendon tears.


How is frozen shoulder treatment done?


The frozen shoulder can take up to 3 years to heal on its own.

The focus of treatment is on controlling pain and regaining movement and strength through physical therapy.


Non-surgical treatments: Patients who started active treatment with early diagnosis have a high chance of recovery without the need for surgery. Even if surgery is required, it is necessary to continue physical therapy afterwards. Some special exercises need to be done in a disciplined way. Medications and intra-articular injections are used for pain control. One of the rarely used methods is to fill the joint with plenty of fluid and to stretch the capsule (hydrodilation).


Physical therapy: The main spine therapy for recovery is physical therapy.

Medications, injections, and surgeries are all done to help. In order to regain movement, it is necessary to do special exercises. These can be done under the supervision of a physical therapist or through a home program. Therapy includes stretching or various motion exercises for the shoulder. Sometimes heat is used to help the shoulder relax before stretching. Simple stretching movements that the patient can do on his own should be done with discipline every day.


Surgical treatment: It is preferred in patients whose treatment was initiated in the first stage and did not recover. Surgical decision is usually made in the 2nd stage.

2 types of surgery are performed:


Manipulation: While the patient does not feel anything under anesthesia, the joint capsule, which has contracted while the muscles are completely relaxed, are stretched to provide an 'opening'. It is a closed procedure, it does not require hospitalization. Physical therapy should continue soon after the procedure.


Arthroscopic loosening: A camera is inserted into the joint through a tiny incision and these adhesions are opened with tools such as a pencil (radiofrequency or shaver). The joint capsule is loosened in a controlled manner. Afterwards, strengthening and range of motion are preserved with physical therapy.

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