Frozen Shoulder: Inflammation -- COVID Connection

"From a biological standpoint there's some theories on how if you get COVID, then your body is sort of in a heightened inflammatory state and frozen shoulder fundamentally is an inflammation problem."

"The shoulder capsule -- it's a thin lining around the joint itself -- has to maintain a delicate balance between flexibility, pliability and also integrity. Once you get into this cascade of a little bit of inflammation or microtrauma that leads to more inflammation, that just sets off the whole cycle of adhesive capsulitis where the capsule, which is normally really thin like a piece of tissue paper almost, then becomes really thick and like cardboard, and that's how your shoulder gets tight and you lose range of motion." 

"[Many cases, however] just come out of nowhere."

Michael Fu, shoulder specialist, assistant attending orthopedic surgeon, Hospital for Special Surgery, New York

"Most people are (w)racking their brains to try to figure out what they did, and the reason that they can't figure anything out is for most people, they didn't do anything."

"[This] freezing [phase is] the worst place to be. Any time they try to reach past what their range of motion is, everyone describes it to me like a knife or an ice pick in their shoulders."

"It can be excruciating."

Julie Bishop, chief, division of shoulder surgery, Ohio State University Werner Medical Center

'Frozen shoulder (adhesive capsulitis) strikes roughly two to five percent of the general population, according to the American Physical Therapy Association. Some specialists in the field find they have seen increased cases among patients in the past year-and-a-half, a situation it was felt that may have a connection to the pandemic. No one actually claims knowledge of the exact causes, however.

 

The condition occurs frequently to people in their 40s to age 60; more commonly occurring in women than men. The prevalence of cases is seen among people with underlying health conditions that include diabetes -- most particularly those suffering from Type 1, once called juvenile diabetes; insulin-dependent diabetics and those with thyroid disorders, according to Dr.Bishop. She also suggests that minor injuries can precipitate immobilization for an extended period.

Pandemic-related factors, according to some theories, including infection with the coronavirus, may contribute to frozen shoulder. Italian researchers suggested that "both direct and indirect effects" of infection with COVID may be involved in frozen shoulder development, possibly through inflammation links the infection causes. Another possible cause that was noted was the condition could result from "the sedentary lifestyle forced on these patients by this disease".

There are typically several phases of frozen shoulder progression, initiated in the inflammatory phase characterized by pain. Pain and inflammation become more severe and then stiffness begins to occur as the quality of capsule tissue changes. When the inflammation subsides, sufferers enter the "frozen" or stiff phase where pain is absent but mobility has not been regained. Frozen shoulder, said Dr.Bishop, will eventually "thaw", stiffness disappears and the joint becomes normal.

According to Dr.Fu and other specialists -- when the condition is diagnosed in its inflammatory phase a cortisone injection into the joint can assist in reducing inflammation and pain, and people are then able to begin range-of-motion therapeutic exercises. Over-the-counter anti-inflammatory medications like Advil or Motrin can help as well in managing the inflammation stage.

Frozen Shoulder

• A frozen shoulder is one that has become stuck and limited in movement.
• Frozen shoulder is often caused by inflammation of the capsule, tissue surrounding the shoulder joint.
• Diagnosing frozen shoulder requires a physical examination and possible X-rays or additional tests to rule out other causes of symptoms.
• Physical therapy and anti-inflammatory medication are usually prescribed to treat frozen shoulder.
• Surgery is not usually indicated to treat frozen shoulder unless non-operative treatments have failed to improve range of motion and decrease pain

John Hopkins Medicine