activities
The pain leads to difficulty in practicing daily activities, and the main reason remains an unknown mystery. Frozen shoulder .. The recovery journey may take a few months! It may come after an injury to Kindle that comes slowly and without injury. This condition, known scientifically as (adhesige cabsulitis), is also known by name in the simplified language as frozen shoulder.
It is a condition that occurs when there is severe loss of movement in the shoulder. It may come after an injury or kindle, slowly and without any warnings. We will learn the causes of this condition, how to diagnose it, and how to treat it.
Anatomically
It is necessary to know which part of the shoulder is diseased in this case?
Anatomically, the shoulder is made up of three parts of the bone, which are the scapula, the humerus and the collar bone. There is a cyst known as the joint capsule. This cyst envelops the joint and envelops these parts of the bone that make up the joint, and inside it there is a viscous fluid that facilitates the movement of these parts. This membrane is thin, but it is surrounded by a lot of ligaments and tendons, which gives it strength and immunity and makes it expandable to keep pace with the movement of the joint. It is known that the shoulder joint has great freedom of movement as a result of its unique structure and as a result of the tasks that a person needs to perform during daily activities, from raising the arm above the head to bending it forward or bending it back. The frozen shoulder occurs when there is inflammation in the joint and in the membrane that envelops the joint, which makes this membrane or parts of it stiff and stick together, and this thus leads to a great limitation in its movement and movement of the joint and thus leads to the name known as frozen shoulder.
the reasons
The patient often comes and wonders why I cannot move my shoulder? In fact, the main cause of the vast majority of frozen shoulder cases remains a mystery and the cause is unknown. One of the possibilities or theories is that this inflammation in the joint membrane may be the result of a reaction that occurs as a result of an imbalance in immunity, which leads to the body attacking the capsule or the joint membrane and leading to inflammation in it. This immune defect occurs when the body mistakes this membrane as a foreign body and attacks it with white blood cells and immune cells, leading to inflammation. There is no specific reason for the occurrence of this immune defect, and no one knows why it occurs suddenly. In fact, the frozen shoulder may begin after a slight injury to the shoulder or may occur after a fracture or hair in the shoulder and even after shoulder surgery. In some cases, the condition may occur after wrist or arm fractures when the entire hand and arm are suspended in a medical tie and the movement of using the shoulder decreases for a period of weeks, which leads to this immune imbalance and inflammation in the shoulder and thus to the frozen shoulder. In some cases, a frozen shoulder may occur after surgery in other parts of the body or after a heart attack or angina. But in all cases, the final outcome of this situation, regardless of the factor that led to its emergence, is the occurrence of inflammation in the membrane that covers the joint and the occurrence of determining the movement of the joint.
Symptoms
Symptoms usually consist of shoulder pain and severely limit movement of the shoulder joint. This extreme limitation occurs when the patient tries to move the shoulder by himself and also when another person tries to move the shoulder and help the patient move the shoulder joint. In addition, there may be pain at night and while sleeping and there may be difficulty in practicing daily activities such as dressing, combing hair, or even while eating.
The diagnosis
Usually the diagnosis is made primarily on the basis of the medical history and physical examination. One of the most important points that help diagnose the condition of the frozen shoulder and distinguish it from the case of tendinitis in the shoulder area is that the frozen shoulder is difficult and limited, whether by the patient trying to move the shoulder or by the doctor who also finds it difficult to move the shoulder. This is in contrast to the tendinitis movement, which is usually difficult for the patient when he tries to move the shoulder by himself, but when another person moves the shoulder slowly, the shoulder is completely mobile. As for the regular x-rays, they are usually of no use in diagnosing a frozen shoulder. In some cases, a dye may be injected into the shoulder joint, after which an x-ray of the shoulder is made, and it shows that the area and size of the shoulder joint has significantly decreased from the normal range. In addition, the MRI scans help a lot to show inflammation in the membrane and to ensure that there are no cuts or inflammations in the tendons surrounding the shoulder.
Treatment plan
The treatment plan usually begins with a non-surgical, conservative approach. Although this condition may take time to heal completely, the vast majority of patients respond with time and improve after a few months. The initial goal of the treatment plan is to reduce the severity of inflammation and increase the range of motion in the shoulder. To achieve this goal, the doctor resorts to the use of anti-inflammatory drugs for the joints and tendons. In addition, physiotherapy and rehabilitation is of utmost importance in restoring movement of the shoulder, God willing. Some muscle relaxants and analgesics can also be used, especially before physical therapy sessions, during which warm compresses, massages, and gradual stretching processes are used for the ligaments and tendons around the shoulder joint. These sessions may take a few months, as mentioned earlier, for their results to start appearing. In some cases, the doctor may resort to injecting a cortisone needle that contains dipomdrol, which has an anti-inflammatory property, mixed with a local anesthetic, in order to reduce inflammation within the joint and in the articular membrane to the maximum degree. This needle is very important and provides relief during physical therapy and pain relief.
Surgical intervention
In some chronic cases that do not respond to the plan that we mentioned earlier, and the condition does not improve after months of natural treatment, anti-inflammatory drugs, exercises and stretching, the surgical option becomes important and helps many cases to heal, God willing. There are many surgical options that can be made that help the patient to improve, the most important of which are the following:
Joint movement under general anesthesia
This is a surgery or a simple intervention that is done by giving the patient a general anesthesia and a muscle relaxant and then the doctor moves the joint forcefully and slowly inside the operating room and when the patient is under anesthesia so that these movements lead to a forced lengthening of the capsule or the membrane that surrounds the joint, which has been exposed to infections as a result the disease. This operation helps a lot to increase movement in the shoulder, after which intensive physiotherapy sessions are performed. In some cases, the forced joint movement process may be resorted to under anesthesia a few times until the patient benefits completely and the movement returns completely to the joint. This operation to lengthen the capsule and restart the movement must be done under the supervision of an experienced consultant doctor because there is a slight risk that the bone will break during movement or that the veins and arteries around the shoulder area will be injured if this surgery is performed by non-specialists. But this risk is simple and rarely happens, praise be to God.
If all the treatment plans mentioned above, including the forced joint movement operation under general anesthesia, fail, the next option is a lengthening and release of the fibrous and thick parts of the joint membrane by using a shoulder arthroscope. This operation is performed under complete anesthesia and with the use of the laparoscope and through two small openings in the front and back area of the shoulder joint, after which the endoscope and the devices that come with it are used to cut some parts of the shoulder joint membrane and release the thick and sticky parts to each other and after the end of the arthroscopy process a forced movement of the shoulder . After the operation, the patient returns to the practice of intensive physical therapy. This surgery is one of the day surgeries and its success rate in helping to restore the shoulder to normal movement is above 80%, God willing.
Tips and recommendations
Frozen shoulder is a well-known condition, praise be to God, and it is not common, but it is accurately diagnosed and the disease is explained in detail to the patient in order for the patient to comply and understand the disease because treatment requires patience and perseverance on the part of the patient to do exercises and physical therapy, whether the patient needs surgical intervention or not. And physical therapy and the recovery journey may take a few months, so the patient must be patient and not lose hope and adhere to the treatment plan. The vast majority of these patients will improve, God willing, and the movement in the shoulder will return in a satisfactory way, leading to the patient or patient being able to return to the normal life and daily activities, God willing, for the joint. This operation to lengthen the capsule and restart movement must be performed under the supervision of an experienced consultant because there is a slight risk that the bone will break during movement or that the veins and arteries around the shoulder area will be injured if this surgery is performed by non-specialists, but this risk is simple It rarely happens, thank God.
