Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition affecting your shoulder joint. Most patients experience pain and stiffness that develops gradually and gets worse over time; this results in the shoulder becoming very hard to move. Usually after a period of worsening symptoms, the frozen shoulder tends to get better, though full recovery may take up to three years.
Our shoulder is made up of three bones that form a ball-and-socket joint – upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). A tissue, referred to as the shoulder capsule, surrounds the shoulder joint and holds everything together. In patients suffering from frozen shoulders, the capsule becomes thick and tight, and bands of scar tissue form, to the extent that it limits motion.
Signs and Symptoms
Pain and stiffness are the main symptoms of a frozen shoulder. Most patients feel a dull ache in the shoulder, and pain in the area around the shoulder, which can extend from the base of the neck to the top of the arm. This pain can get worse at night, making it difficult to sleep and lie on the side.
Frozen shoulder tends to occur in three stages; each stage has its own unique symptoms as well as an approximate timeline.
Stage 1: Freezing Stage
The pain increases gradually over a period of six weeks to three months. As the pain continues to worsen, your shoulder loses range of motion.
Stage 2: Frozen Stage
In this stage, the symptoms of pain may improve, however the stiffness remains. Hence, moving your shoulder may become more difficult and as such you may not be able to perform certain daily activities. This stage can last between four to 12 months.
Stage 3: Thawing Stage
In the thawing stage, you may find your shoulder motion improving. However, the complete return to normal or close to normal strength and range of motion may take between six months to three years.
Causes and Risk Factors
As mentioned above, the bones, ligaments, and tendons making up your shoulder joint are encased in a capsule of connective tissue. When this capsule thickens and tightens around the joint, it causes frozen shoulder. While doctors are still unsure as to why this happens to some people, people with diabetes, heart disease or had to immobilise their shoulder for a prolonged period are at higher risk of developing this condition.
Diagnosis
During the physical examination, your doctor or orthopaedic specialist may ask you to make certain shoulder movements to check for pain and evaluate your range of motion. They may also ask you to relax your muscles while they move your arm. Besides signs and symptoms, your doctor may also suggest imaging tests such as X-rays or an MRI scan to rule out other causes, such as rotator cuff tears (tears of the muscles that stabilise the shoulder) and shoulder arthritis.
Treatment
Although it may take up to three years for your frozen shoulder to get better, your condition generally improves over time. As such, the focus of treatment is to control pain, restore motion as well as strength through physical therapy. In addition to physical therapy, your orthopaedic specialist may also prescribe non-steroidal anti-inflammatory drugs to help reduce the pain and inflammation associated with frozen shoulders.
If your shoulder continues to be painful and stiff after 6 months, affecting your ability to perform daily activities, your doctors may suggest steroid injections or joint distension to improve your symptoms. Surgery is only considered in cases where conservative treatment proves to be ineffective. This involves an arthroscopic (keyhole) shoulder procedure to remove the scar tissue inside the shoulder joint, and release the capsule, and can be done with a manipulation under anaesthesia.
Every case is different; hence it is best to consult an orthopaedic surgeon for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you suspect that you are suffering from a frozen shoulder and let us help you enjoy a better quality of life.
Frequently Asked Question (FAQ)
1) Is surgery always necessary for frozen shoulders?
No, surgery is not always necessary for frozen shoulders. Most cases can be effectively managed with conservative treatments. These include physical therapy, pain medications, corticosteroid injections, and in some cases, joint distension (a procedure where sterile water or saline is injected into the joint to help stretch the capsule and improve mobility). These treatments aim to reduce pain, improve range of motion, and break up adhesions in the shoulder joint. Surgery is typically considered when conservative treatments fail to provide relief or if there are severe restrictions in shoulder mobility that significantly impact daily activities.
2) Can frozen shoulders recur after treatment?
Yes, in some cases, frozen shoulders can recur or develop in the other shoulder. Recurrence rates vary, but it is estimated that around 10% to 15% of individuals may experience a recurrence. However, with proper treatment and ongoing exercises to maintain shoulder mobility, the risk of recurrence can be reduced. It is important to continue with rehabilitation exercises even after symptoms improve to prevent stiffness and promote long-term shoulder health.
3) Can frozen shoulders be cured completely?
While frozen shoulders can be a persistent condition, most people experience significant improvement in pain and mobility over time with appropriate treatment. Complete resolution of symptoms is possible, but it may take several months to years. It is important to note that the recovery process varies for each individual. Patience and adherence to the treatment plan, which may include physical therapy exercises, pain management, and other modalities, are key to achieving the best possible outcome.
4) What complications can arise from frozen shoulders?
Frozen shoulders can lead to several complications. The limited range of motion and stiffness in the shoulder joint can result in muscle weakness and reduced function in daily activities. For example, reaching overhead, lifting heavy objects, or performing simple tasks like dressing and combing hair may become challenging. The pain associated with frozen shoulders can also interfere with sleep, causing difficulty in finding a comfortable sleeping position. In rare cases, long-term restrictions in shoulder mobility can lead to muscle imbalances and secondary shoulder problems, such as rotator cuff injuries or impingement syndrome. However, with early diagnosis and appropriate treatment, the risk of complications can be minimised, and most individuals can regain full or near-full function of the shoulder joint.