What are the Causes?

• The exact cause is not clear. It is more common in women than in men and usually occurs between the ages of 40 and 65.
• Soft tissue lesions, tendinitis, bursitis in the shoulder region,
• 10-20% of patients are diabetic (more difficult to treat)
• Hyperthyroidism, cardiovascular diseases, depression, Parkinson’s disease.
• Neck hernia and calcifications, – Fracture, shoulder dislocation, traumas.
• Again, it is more common in sensitive people with a low pain threshold.
• Again, it is more common in sensitive people with a low pain threshold.
• Overuse of the arm, excessive physical activity, competitive sports, housewives, overhead level workers (repetitive strain disorder, repetitive trauma disorder)

How the disease progresses?
The disease has 3 phases.

1. Inception period: There is pain and mild limitation in movements. Movement limitation gradually increases. Pain increases especially at night. This period lasts 2-9 months

    

2. Freezing period: The pain is relatively reduced and patients can use their arms more comfortably. but shoulder movements are almost completely frozen. This period lasts for 4-9 months.

    

3. Thaw period: There is a gradual improvement. This period varies between 12-24 months. X-ray findings are usually normal, tendon and bursa calcifications can be seen on X-rays, neck radiographs should be evaluated. Ultrasound and MRI may provide detailed information in some patients.

Type of Treatment
Treatment differs according to the stage of the disease. The disease tends to improve over time and treatment aims to shorten this process. Once treated, shoulder range of motion should be maintained.

1. Medication and exercise therapy; Exercises taught by physiotherapists in combination with pain-relieving anti-rheumatic drugs are recommended in the early stages of the disease. Exercises can be painful, but doing them regularly can prevent the development of shoulder mobility restriction. Warming the shoulder before starting the exercises – applying heat reduces pain and increases range of motion. After exercise, cold-ice is applied to reduce inflammation.
2. Physical therapy; Physical therapy and exercises help to regain shoulder movements and should be started immediately in cases where the limitation of shoulder movements continues to increase. Shoulder physiotherapy requires special expertise and experience. Excessive strain may cause the disease to accelerate. Depending on the course of the disease, it may take up to 2-12 months. Following home exercises during physiotherapy reduces the duration of physical therapy and increases its effect.
3. Intra-shoulder injections; (local anesthetics or steroids can be used); It is a highly effective method used if the response to physical therapy is low or if therapy cannot be performed completely due to excessive pain. Classical cortisone side effects are not seen due to the dose and type of corticosteroid administered. In the early period, many patients have a dramatic improvement after the injection.
4. Manipulation under general anesthesia; In patients who do not respond to previous methods, especially in Stage III, the adhesions are ruptured by forcing the narrowed capsule of the shoulder under general anesthesia. In the meantime, a capillary tube is placed on the cervical nerves and painkillers are administered through this tube after the procedure and movement and physical therapy are started immediately and re-adhesions are prevented. This procedure should be performed very carefully and by experienced people. Excessive strain may cause a fracture in the shoulder. If the shoulder cannot be opened with gentle maneuvers, the procedure should be stopped and shoulder arthroscopy should be performed.
5. Shoulder arthroscopy; It is a preferred method when adequate release cannot be achieved by manipulation during general anesthesia or in people with severe shoulder movement limitation.