What is a Frozen Shoulder?
Frozen shoulder, also called adhesive capsulitis, is a condition that causes stiffness and pain in the shoulder joint. It typically develops gradually, worsening over time, and can severely limit the shoulder’s range of motion. The condition occurs when the capsule surrounding the shoulder joint thickens and tightens, restricting movement. The exact cause of a frozen shoulder is not fully understood, but it is often associated with inflammation, scarring, and prolonged shoulder immobilisation.
Recognising the Symptoms of Frozen Shoulder
Frozen shoulder symptoms develop in stages, progressively worsening over time. Common symptoms include:
Pain
The first symptom is usually a dull or aching pain in the shoulder. This pain can extend down the arm and worsen with movement and is often worse at night, disrupting sleep.
Stiffness
As the condition progresses, the shoulder becomes increasingly stiff. This stiffness restricts the range of motion, making it difficult to perform daily activities such as reaching, lifting, and dressing.
Limited Range of Motion
Both active (self-initiated) and passive (assisted) shoulder movements are significantly limited. This limitation impacts normal shoulder use.
Weakness
Muscle weakness may develop over time due to pain and limited use of the shoulder, further impairing shoulder function.
Swelling
Mild swelling around the shoulder joint may occasionally be present. It contributes to discomfort and restricted movement.
What Causes Frozen Shoulder
While the exact cause of frozen shoulder is unknown, several risk factors contribute to its development.
Immobilisation
Prolonged immobilisation due to surgery, injury, or a chronic condition can cause the tissues around the joint to stiffen, leading to pain and restricted movement.
Inflammation and Scar Tissue
Conditions such as tendinitis, bursitis, or injury can cause the shoulder capsule to thicken and tighten, leading to inflammation and scar tissue formation that restricts movement.
Age, Gender, and Associated Conditions
Frozen shoulder is more common in individuals aged 40 to 60 and is more prevalent in women, possibly due to hormonal changes. Conditions like diabetes, thyroid disorders, cardiovascular disease, and Parkinson’s disease increase the risk by affecting connective tissues or the immune system.
Previous Shoulder Injury or Surgery
Shoulder injuries or surgical procedures that require prolonged immobilisation increase the risk, causing stiffness and limiting movement.
The Three Stages of Frozen Shoulder
Frozen shoulder progresses through three stages, each with distinct symptoms:
Stage 1: Freezing Stage
This stage lasts from 6 weeks to 9 months. Pain increases gradually, and shoulder movement becomes restricted. Pain is often worse at night, making it difficult to sleep.
Stage 2: Frozen Stage
This stage lasts from 4 to 6 months. Pain may begin to subside, but the shoulder becomes stiffer, and the range of motion is significantly reduced. Daily activities become increasingly difficult.
Stage 3: Thawing Stage
This stage can last from 6 months to 2 years. Shoulder mobility gradually improves, and pain continues to decrease. However, some residual stiffness and discomfort may persist for a longer period.
Diagnosing a Frozen Shoulder
Diagnosing a frozen shoulder involves a combination of clinical assessment and imaging tests.
Medical Review
The doctor reviews the onset and progression of symptoms, including the duration and severity of pain, range of motion limitations, previous shoulder injuries or surgeries, and associated medical conditions such as diabetes or thyroid disorders.
Physical Examination
The doctor evaluates the shoulder’s range of motion to identify movement limitations. Specific movements, such as arm elevation, external rotation, and internal rotation, are performed to assess functionality. Areas of pain are pinpointed to assess the extent and location of discomfort.
Imaging Tests
Imaging tests are used to confirm the diagnosis and rule out other conditions that may cause similar symptoms. X-rays help rule out arthritis and fractures, while MRI provides detailed images of soft tissues to identify inflammation, scar tissue, and other abnormalities. Ultrasound helps assess soft tissues around the shoulder, particularly in evaluating tendons and detecting inflammation.
Treatment Options for Frozen Shoulder
Treatment for a frozen shoulder primarily focuses on alleviating pain and restoring range of motion to the shoulder.
Non-Surgical Treatment
Non-surgical approaches are the first line of treatment to ease symptoms and enhance movement.
Physical Therapy
A tailored exercise programme is developed to improve shoulder flexibility and strength. The programme includes stretching and strengthening exercises to restore range of motion. Heat therapy may be used to relax muscles and reduce pain. Consistent participation is necessary for gradual improvements in mobility.
Medication
Medications for frozen shoulder include nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen to reduce pain and inflammation. In more severe cases, corticosteroid injections directly into the shoulder joint provide relief, especially in the early stages. For acute inflammation, a short course of oral steroids may also be prescribed to help manage symptoms.
Surgical Treatment
Surgery is considered when non-surgical treatments fail to relieve symptoms after several months.
Arthroscopic Surgery
This procedure involves the use of a small camera (arthroscope) to view and operate inside the shoulder joint. The surgeon makes small incisions around the shoulder and cuts the tight and thickened parts of the shoulder capsule to release tension and improve movement. Recovery typically requires physical therapy to maintain the improved range of motion.
Manipulation Under Anaesthesia
This is a procedure performed while the patient is under general anaesthesia. The surgeon forcefully moves the shoulder to break up the adhesions and scar tissue. This procedure can be combined with arthroscopic surgery for better outcomes. It requires follow-up physical therapy to maintain mobility gains.
Tips to Prevent a Frozen Shoulder
Preventing a frozen shoulder involves proactive measures to maintain shoulder health and avoid stiffness. Key strategies include staying active and avoiding prolonged immobility, especially after shoulder injuries or surgeries. Incorporating regular range-of-motion exercises into your routine can keep the shoulder joint flexible and reduce the risk of stiffness. Additionally, maintaining good posture helps prevent strain on the shoulder and supports overall joint health.
Conclusion
Frozen shoulder is a condition that causes pain, stiffness, and limited mobility in the shoulder joint, often due to immobilisation, inflammation, or underlying health conditions like diabetes. Early intervention with non-surgical treatments, including physical therapy and medications, can improve symptoms. In more severe cases, surgical options may be necessary, followed by rehabilitation. Consulting an orthopaedic specialist and adhering to treatment plans are key steps toward maintaining shoulder mobility and overall health.
For personalised advice and effective treatment for shoulder conditions, including frozen shoulder, schedule a consultation with Dr Wang Lushun today.
