Disease Description (Causes and Symptoms)
- Definition: A condition characterized primarily by pain and limited joint movement caused by adhesion and contracture of the shoulder joint capsule and surrounding soft tissues (adhesive capsulitis, commonly called frozen shoulder).
- Causes·pathophysiology: Although the cause is unclear, it is associated with age (middle-aged and older adults), prolonged nonuse of the shoulder (after immobilization or hospitalization), repetitive microtrauma, and systemic metabolic diseases (particularly diabetes and thyroid disease). Inflammation of the joint capsule progresses to fibrosis and adhesion, limiting the range of joint motion.
- Main symptoms: Gradively onset shoulder pain (especially pain at night), limitation of both active and passive movement (particularly limited external rotation), and difficulty with daily activities such as washing the face, combing the hair, and fastening buttons.
- Clinical course (stages): ① Painful stage (approximately 0–3 months): Severe pain and the beginning of limited active movement. ② Frozen stage (3–12 months): Pain improves, but passive ROM limitation becomes pronounced. ③ Thawing stage (12–18 months or longer): Pain almost disappears, and ROM gradually recovers, although complete recovery may be slow.
- Diagnostic points: Clinical diagnosis (reduced active and passive ROM, especially reduced external rotation). Plain radiographs are usually normal, but may be taken to rule out other lesions (bony changes, dislocation, calcific tendinitis, etc.). If necessary, ultrasound or MRI may be used to identify rotator cuff lesions and calcification.
Treatment Methods
- Basic principles: Pain control → gradual rehabilitation (exercise therapy) to maintain and restore joint mobility → consideration of injections, procedures, or surgery in refractory cases.
- Medication: Pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs). Short-term use of analgesics when pain control is needed.
- Injection therapy: Local anesthetic + steroid injections into the affected area (intra-articular or injections into surrounding tissue) reduce pain and inflammation, facilitating exercise rehabilitation. Follow the physician’s instructions regarding the number of injections and dosage.
- Physical therapy·exercise therapy: Heat therapy, electrotherapy, passive and active range-of-motion exercises (pendulum exercises, stretching, isometric strengthening), etc. When pain is severe, avoid excessive stretching and gradually expand the range of motion.
- Procedures·surgery: If there is no improvement after conservative treatment (for several months or longer) or if daily activities are severely limited
- Arthroscopic capsular release
- Manipulation under anesthesia — consider the risk of complications The decision varies depending on the duration of symptoms, degree of functional impairment, and accompanying lesions.
- Lifestyle management·self-care:
- Move the shoulder gently and regularly as much as possible to avoid immobilization.
- When pain is severe, relieve symptoms with cold or warm compresses.
- Excessive and abrupt forced stretching may worsen pain or cause other injuries, so perform it under professional guidance.
- Risk of complications: If left untreated for a long time, persistent joint stiffness, decreased muscle strength, and difficulty walking or sleeping may occur. Infection and elevated blood glucose levels may occur after injections (especially in patients with diabetes).
- Prognosis: It generally improves over several months to 1–3 years, but some people may not recover completely and may have residual limitation. The course may be longer and recovery more limited in patients with diabetes and others.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items/documents to prepare
- List of medications currently being taken (especially anticoagulants, steroids, diabetes medications, etc.)
- Previous test results (shoulder X-ray, ultrasound, MRI, etc.) or files if they can be brought in
- When the symptoms began and their course (dates, patterns of worsening and improvement)
- Degree of pain (pain scale 0–10), presence of night pain, and activities of daily living that are limited (washing the face, combing the hair, getting dressed, etc.)
- Recent hospitalizations, injuries, and surgical history, as well as systemic diseases (diabetes, thyroid disease, cardiovascular disease, etc.)
- Previous treatments received (duration and number of physical therapy sessions, injection history, etc.) and their effects
- Suggested materials to show the doctor during the outpatient visit
- A symptom diary recording pain and limited movement (e.g., weekly pain scores and a list of movements that cannot be performed)
- Previous images (DICOM files/photos if possible)
General Examples of Questions to Ask the Doctor
- What is the exact diagnosis of this condition? Is a plain radiograph alone sufficient?
- What initial treatment (medication, exercise, or injection) is recommended, and when can the expected effects begin to appear?
- What are the benefits and risks of steroid injections (particularly the effect on blood glucose in people with diabetes)?
- How can I safely begin physical therapy (exercise therapy) at home? What should the schedule be?
- When should surgery or a procedure (arthroscopic release or manipulation under anesthesia) be considered? What are the benefits and risks of surgery?
- What is the prognosis of this condition, and how likely is complete recovery?
Examples of Condition-Specific Questions
- Based on my condition (degree of pain, ROM examination results, presence or absence of diabetes, etc.), how many months of conservative treatment do you plan to provide before recommending a procedure or surgery?
- How many steroid joint injections can I safely receive? How should I manage my blood glucose after the injection (if I have diabetes)?