Frozen shoulder is the common term for adhesive capsulitis. The Cleveland Clinic reports that 10 to 20 percent of diabetics are affected by adhesive capsulitis. In this disease process, the shoulder capsule becomes inflamed. It contracts and thickens, resulting in pain and loss of motion. The American Diabetes Association notes that pain and stress can cause fluctuations in blood glucose, so it is important to monitor blood glucose in diabetics during treatment.
Disease Progression
In adhesive capsulitis, initially the shoulder is very painful, then loss of motion occurs. This stage is the freezing stage. The next stage is the frozen stage. Motion is limited, but the pain is decreased. The final stage is the thawing stage. The disease typically resolves after two years. If nothing is done, there may be some loss of shoulder motion. The goals of treatment are to decrease pain and have normal shoulder motion. Care of a frozen shoulder will probably involve several different treatments.
Therapy
The goal of therapy is to maintain normal motion while not aggravating the shoulder. A physical therapist may try TEN, or transcutaneous electrical nerve stimulation, or other treatments. The therapist will instruct the patient on exercises to be done at home every day. If attempts to regain motion are too aggressive, the shoulder could become more inflamed. Icing the shoulder around exercise times may reduce the inflammation. Heat may also help the pain.
Medications
The Hospital for Special Surgery's first choice for oral pain medications are nonsteroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen. These medications address the inflammation that is occurring in the shoulder. Dependent on an individual's condition, narcotic pain medication could be prescribed.
A physician may inject the frozen shoulder with cortisone and an anesthetic. MayoClinic.com notes that cortisone reduces inflammation.
Anesthesiologists can also do different types of pain blocks by injecting anesthetic near the nerves in the neck. For chronic pain, Brigham Women's Hospital treats some patients with a stellate ganglion block. This decreases the pain sensation but allows normal arm motion. Risks of pain procedures include allergic reaction, lung collapse, and hoarseness.
Surgical Treatments
For shoulder anesthesia, Massachusetts General Hospital lists choices as interscalene and supraclavicular blocks. The arm is numb for up to 18 hours afterward. This allows the patient to participate in therapy shortly after surgery. The patient can also be put to sleep during the surgery using a general anesthetic.
To manipulate the shoulder under anasthesia, the surgeon moves the affected shoulder through a normal range of motion while the patient is asleep or the shoulder is numbed with an anesthetic. In a procedure called distension, the doctor injects the shoulder with a large amount of normal saline to expand the joint capsule. There is a small risk of fracturing the arm with manipulation.
If arthroscopic surgery is called for, a small camera--an arthroscope--is inserted into the shoulder joint. Using shavers, and special blades the tight portions of the shoulder joint capsule are released. If the surgeon is not able to adequately release the shoulder through the arthroscopic incisions, he may make an incision over the front of the shoulder and open the capsule.
Recovery
Recovery is a slow process since the normal disease course is two years. Most patients seek some treatment for their shoulder, but many wait until the symptoms are severe and motion loss has occurred. The quickest results are obtained when treatment is started early in the disease course.
When physical therapy, pain medication, and nerve pain blocks are used, the American Academy of Orthopaedic Surgeons reports that 90 percent of patients regain full shoulder motion. For the 1 in 10 who undergo surgery to restore shoulder function, three to six months more therapy is recommended to maintain motion.
While it is unusual to have both shoulders affected simultaneously, it is not uncommon for diabetics to develop adhesive capsulitis in their opposite shoulder a few years later. A diabetic's best method of preventing frozen shoulder is doing exercises that maintain full motion of both shoulders. Reporting new shoulder symptoms to the physician will allow treatment to begin early when it is most effective.
References
- American Diabetes Association: Living with Diabetes-Stress
- Hospital for Special Surgery: Adhesive Capsulitis-Conditions and Treatment
- Cleveland Clinic: Frozen Shoulder vs Adhesive Capsulitis
- Brigham and Women's Hospital: Stellate Blocks in Pain Management
- Massachusetts General Hospital: ACS-Interscalene Blocks
