Have you ever experienced pain or stiffness in the shoulder joint that limited your movement and made motion next to impossible? If you have, it’s highly likely you had a bout with frozen shoulder.
A frozen shoulder (a.k.a. adhesive capsulitis) is a painful condition where the shoulder joint capsule — a strong connective tissue surrounding the shoulder joint — becomes stiff, thick, and inflamed. The shoulder then loses its ability to facilitate normal motion and causes sometimes unbearable pain.
This medical condition came to be known as ‘frozen shoulder’ primarily because the more you feel pain in the affected shoulder, the less likely you will use it. The period of disuse then causes the shoulder joint capsule to get thicker and tight — thereby making it even more difficult to move. In effect, the shoulder becomes frozen or rigid in its position.
What leads to a frozen shoulder?
The exact cause of frozen shoulder is not known. However, it can emerge from a local shoulder injury, such as tendinitis, bursitis, and rotator cuff injury. But more often than not, a frozen shoulder develops with no identifiable cause or incident. The difficult thing about frozen shoulder is that it can last from a few months up to 3 years.
Are there risk factors to developing a frozen shoulder?
Although the cause of frozen shoulder remains a mystery, it is known to afflict 3 per cent of people in their lifetime. However, the probability of developing frozen shoulder also increases with certain risk factors mentioned below:
- It affects mostly adults between the age of 40 and 60.
- More women than men experience frozen shoulder.
- It is more common among people with medical conditions, such as diabetes, tuberculosis, Parkinson’s disease, heart disease, or an overactive or underactive thyroid. In particular, it has been found that 10 to 20 per cent of people with diabetes mellitus develop frozen shoulder.
- It can develop in people who have suffered from a previous injury, immobility, or reduced mobility because of a stroke, an arm fracture, or surgery (e.g., mastectomy).
Signs and symptoms of frozen shoulder
When frozen shoulder develops, it usually involves three distinct phases:
- Freezing stage (6 weeks to 9 months): The shoulder starts to stiffen and becomes painful to move. The pain gradually worsens, especially at night. There is a marked reduction in shoulder mobility until movement becomes too painful.
- Frozen stage (2 to 6 months): During this period, the pain may reduce, although the shoulder remains stiff. Completing daily tasks and engaging in normal activities remain difficult and painful.
- Thawing or recovery stage (6 months to 2 years): As the shoulder begins to ‘thaw,’ there is a marked reduction in pain, just as shoulder mobility slowly improves. Complete or near full recovery may happen as normal strength and motion are restored.
There are instances when the previously frozen shoulder never regains its complete normal range of motion. In such cases, the patient needs to seek medical advice concerning therapies or exercises they can perform to improve their condition.
Diagnosing frozen shoulder
When you go to the doctor to get checked for frozen shoulder, you can expect to undergo the following steps:
- Your doctor will review your medical history and talk to you about the symptoms you may be experiencing.
- You will undergo a physical examination of the arms and shoulders.
- To assess the range of motion in the affected shoulder, your doctor will initiate some movements there and note any pain you experience with each action. This process where you remain passive or do nothing as the doctor moves your affected arm is referred to as evaluating your ‘passive range of motion.’
- Your doctor will also ask you to move your shoulder to assess your ‘active range of motion.’
- After assessing both types of motion, your doctor can make an initial diagnosis. Note that for people with frozen shoulder, both active and passive motions are greatly diminished.
Once these preliminary steps are done, you may be asked to get X-rays of your shoulder to ensure the symptoms are not caused by another medical condition like arthritis. There’s usually no need for you to undergo more advanced imaging tests (e.g., ultrasound, magnetic resonance imaging) unless it’s to check for other possible problems.
Frozen shoulder treatment
The treatment of frozen shoulder is usually focused on alleviating pain until the initial stage passes. However, if the problem continues, therapy and surgery may be recommended to restore motion in the affected area.
There are some simple treatment options available that are designed to reduce pain. These include:
- Applying hot and cold compresses to reduce pain and swelling in the area.
- Taking pain medicine that also helps with inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol®), and ibuprofen (Advil®, Motrin®). Depending on the severity of your pain, your doctor might also prescribe painkillers and anti-inflammatory drugs. They could also recommend steroid injections (e.g., cortisone) directly into the shoulder joint for unmanageable pain and swelling.
- Working with a physiotherapist and performing certain stretching and range of motion exercises.
- Embarking on a home exercise program designed to reduce pain and improve motion.
- Undergoing transcutaneous electrical nerve stimulation (TENS) that works to reduce pain by blocking nerve impulses.
However, if no visible improvement is observed after a year of trying these simple treatments, the following surgical methods could be recommended:
- Manipulation under anaesthesia where your doctor will attempt to force shoulder movements while you are unconscious. The goal here is to loosen the stiffness by gently stretching or tearing the joint capsule, thereby leading to an improvement in the shoulder’s range of motion.
- Performing a shoulder arthroscopy. Here, your doctor will make tiny cuts through the tight sections of the joint capsule to initiate capsular release.
To yield the best results, these two procedures are usually applied together.
Frozen shoulder prevention
Many patients spend large amounts of money trying all types of treatment to help this condition with little success.
The key is getting it diagnosed early, and have your physiotherapist guide you along the process, showing you which regime of exercises and self-help strategies are most effective for the stage of the condition you are at.