Frozen shoulder syndrome

Frozen shoulder syndrome or also called adhesive capsulitis of the shoulder joint are two terms used to describe the condition of soreness and stiffness in the shoulder.

Recent definitions of the disease describe it as "a condition of unknown etiology characterized by limitation of both active and passive movements in the shoulder without the presence of other diseases affecting the shoulder joint".

The most important distinguishing characteristic of the disease is the loss of passive movements, which differentiates it from other conditions in which there is also tenderness and restriction of active movements in the shoulder, but passive movements are preserved.

Such diseases are, for example, subacromial bursitis, calcific tendinitis, partial tear of the rotator cuff, etc.

Depending on whether there are other diseases or traumas that can provoke the condition or similar ones are absent, the syndrome is divided into primary or secondary-onset.

In order to put the definition of "frozen shoulder syndrome", it is necessary that the duration of symptoms exceeds at least 1 month, and that the complaints have reached the so-called "plateau" phase or are getting worse.

Patients with primary "frozen shoulder" syndrome have no anamnestic, clinical, or radiographic evidence of other disease that could explain the onset of pain and limited shoulder motion.

There are three phases that classically describe the course of the disease:

1. Фаза на „замръзване” (болкова фаза);
2. Фаза на сковаване (с ограничаване на активните и пасивни движения);
3. Фаза на „размразяване (с постепенно възстановяване на движенията в рамото).

What are the symptoms of frozen shoulder syndrome?

In the initial (pain) phase or the "freezing" phase, characteristic complaints are:

• Постепенна поява на неясна, тъпа болка в мястото на инсерция на делтовидния мускул;
• Поява на болка при движения в рамото;
• Непоносима болка през нощта, която води до невъзможно спане на засегнатата страна и в крайна сметка до сънна депривация;
• Значително ограничение на активните и пасивни движения в рамото, свързани с неговата ротация – в най-висока степен е ограничена външната ротация на рамото.

The duration of the first phase may be within weeks to months

In the second phase (the "frozen shoulder" phase), patients report the onset of stiffness and almost complete restriction of movement in the shoulder. Pain is no longer the leading symptom. Movements of the arm above the head, to the side, crossing in front of the chest or behind the back are restricted, and dressing becomes difficult. On average, the second phase may last about a year.Often years after the syndrome develops in one shoulder, the contralateral shoulder may also be affected.

In the third phase (the "thawing" phase), a gradual stiffening of the shoulder is noted. Typically, once this phase has occurred, it takes about 9 months on average to fully restore the previous mobility in the shoulder.