Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder, also referred to as adhesive capsulitis, is a condition that limits shoulder movements and causes pain.

Usually, a frozen shoulder develops when the shoulder joint capsule (strong connective tissue near the shoulder joint) thickens, stiffens, and becomes swollen. The joint capsule comprises ligaments that secure the humeral head (top of the upper arm bone) to the glenoid (shoulder socket), keeping the joint in position. Its commonly referred to as a ball and socket joint.

The more discomfort you experience, the less likely you are to use the shoulder, hence the term ‘frozen’ shoulder. The shoulder capsule tends to thicken and tighten when not used; thismakes it hard to move the shoulder as it is ‘frozen’ in its place.

Symptoms of Frozen Shoulder

Frozen shoulder usually develops gradually in these 3 stages:

• Freezing stage: Any shoulder movement triggers pain, and its range of motion is restricted. This phase lasts between 2 and 9 months.
• Frozen stage: Although pain may reduce in this stage, the stiffness increases, and using the shoulder becomes harder. This phase can last between 4 to 12 months.
• Thawing stage: The range of motion in the shoulder starts getting better. This phase lasts between 5 to 24 months.

In some cases, the pain becomes worse during the night and can even disrupt sleep.

Causes

The connective tissue capsule surrounds the shoulder joint. When the capsule becomes thicker and tighter near the shoulder joint, it limits its movement, causing a frozen shoulder.

The reason this occurs to some individuals is unclear. However, the chances of occurrence are higher after the shoulder remains still for prolonged periods, like post-surgery or arm fracture.

Risk factors

These factors are likely to increase the risk of a frozen shoulder:

• Age and gender: Individuals aged 40 and above, especially women, are at a high risk of developing frozen shoulder.
• Immobility or reduced movement: Keeping the shoulder still increases the chances of having a frozen shoulder. Some of the factors that can lead to limited movement are broken arm, rotator cuff injury, stroke, and post-surgery recovery.
• Systemic diseases: Certain medical conditions are likely to contribute to frozen shoulder in some people. Examples of these diseases are diabetes, cardiovascular disease, overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), and Parkinson’s disease.

How to Diagnose Frozen Shoulder

Frozen shoulder or adhesive capsulitis diagnosis involves evaluating the symptoms and reviewing the medical history. The healthcare provider will also conduct a physical examination of the shoulders and arms by:

• Moving the shoulder and arm in every direction to assess the range of motion and checkfor pain. This kind of examination is referred to as evaluating the ‘passive range of motion.’

• Watching the shoulder movement to determine the ‘active range of motion.’

• Comparing both motions. Those with a frozen shoulder usually have a restricted range of passive and active motion.

To rule out other possible problems causing symptoms, such as arthritis, a shoulder X-ray may be ordered. Advanced imaging tests, including ultrasound and magnetic resonance imaging (MRI), are usually not necessary when it comes to frozen shoulder diagnosis. The medical provider can, however, recommend them to check for other disorders like rotator cuff tear.

Prevention

Keeping the shoulder still while recuperating from a fractured arm, shoulder injury, or stroke is the main cause of a frozen shoulder. You should thus consult your provider concerning exercises to maintain shoulder joint mobility if you suffered from an injury that restricts shoulder movement.

 

Frozen Shoulder Treatments Options

Frozen shoulder treatment primarily involves shoulder pain management and preservation of as much shoulder range of motion as possible. The treatment options include:

Medications

Painkillers, like ibuprofen (Advil, Motrin IB) and aspirin, can help ease inflammation and discomfort caused by a frozen shoulder. The doctors may sometimes recommend stronger anti-inflammatory and pain-relieving medications.

Therapy

A physical therapist can help guide you through a range of motion activities and exercises to restore shoulder movement. Commitment and consistency in performing these exercises are essential to regaining movement.

Surgery and other procedures

Most cases of frozen shoulders usually improve in 12 to 18 months on their own. But for persistent and severe symptoms, additional treatments may include:

• Steroid injection: Corticosteroids injected into the shoulder joint can help reduce pain and enhance overall movement, mainly if they are administered immediately after the condition begins.
• Hydrodilation: This involves sterile water injection into the joint capsule to stretch the tissue and facilitate easy joint movement. Sometimes, hydrodilation can be combined with steroid injection.
• Shoulder manipulation: This is performed under general anaesthesia when you are asleep and can’t feel any pain. During the procedure, the shoulder joint is moved in various directions to loosen the stiffened tissue.
• Surgery: Although surgical operation for the frozen shoulder is uncommon, it may be required to remove scar tissue from the shoulder joint if other options aren’t helpful. The surgery (known as arthroscopy) often involves creating small cuts and inserting small tools guided by a camera into the joint.

Preparing for your appointment

First, you will need to see a specialist to schedule an appointment. Sometimes, you might be referred to a professional known as an orthopedist or physiatrist specializing in bones and muscles treatment.