Frozen Shoulder Treatment

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by stiffness and pain in the shoulder joint.

  • Are your symptoms affecting your quality of life? Consult our MOH-accredited frozen shoulder specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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Causes of Frozen Shoulder

The exact cause of frozen shoulder remains unclear, but the underlying mechanisms are believed to involve inflammation and fibrosis of the joint capsule. Several factors are known to increase its risk:

  • Periods of Immobility: Often begins following an arm injury or surgery, leading to reduced mobility.
  • Age and Gender: More prevalent in individuals over 40 years old, with a higher incidence in women.
  • Medical Conditions: Increased risk associated with certain health issues. This includes conditions such as diabetes, thyroid disorders (both hyperthyroidism and hypothyroidism), cardiovascular disease and Parkinson’s disease.

In some instances, frozen shoulder occurs without any discernible predisposing factors. This leads to its classification into two categories:

  • Primary Adhesive Capsulitis: Occurs without an obvious cause.
  • Secondary Adhesive Capsulitis: Develops following an injury or surgery.

Symptoms and Signs

The main symptom is a progressive decrease in shoulder joint mobility, accompanied by pain. This pain is usually dull or aching and is typically worsened by movement or at night. This can lead to reduced mobility in the shoulder, making it difficult to perform routine tasks such as dressing, reaching overhead, or even combing hair. It is also not uncommon for the pain and stiffness to cause discomfort in the upper arm.

The condition typically evolves through three stages, with varying degrees of pain and immobility:

  • Freezing Stage
    This initial stage is marked by a gradual onset of pain. As the pain worsens, the shoulder loses more of its range of motion. This stage can last from 6 weeks to 9 months.
  • Frozen Stage
    During this phase, the pain might diminish, but the stiffness and limited mobility in the shoulder remain. This stage generally lasts 4 to 6 months, and daily activities can become challenging due to the limited movement of the shoulder.
  • Thawing Stage
    This final stage is characterised by a gradual improvement in the range of motion of the shoulder. It can lead to a complete return to normal or close to normal strength, but the process can last from 6 months to 2 years.

Diagnosis

Diagnosing frozen shoulder typically involves a review of symptoms and a physical examination.

  • Medical History
    Any symptoms, pains, and known factors that could have contributed to the development of the condition are discussed.
  • Physical Examination
    The doctor will assess the range of motion in both shoulders, comparing the affected shoulder with the healthy one. This involves checking for pain when moving the shoulder and noting any limitations in movement.
  • Imaging Tests
    While not always necessary, imaging tests such as X-rays or MRI scans may be used to rule out other conditions that could cause pain and stiffness in the shoulder, such as arthritis or a torn rotator cuff.

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Are Your Symptoms Affecting Your Quality Of Life?

Consult our MOH-accredited frozen shoulder specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.

Non-Surgical Treatment Options

Non-surgical treatments aim to alleviate pain and restore range of motion.

  • Pain Relief Medications - Over-the-counter pain relievers such as ibuprofen, aspirin, or acetaminophen can help reduce pain and inflammation.
  • Corticosteroid Injections - These are administered directly into the shoulder joint. They can reduce pain and improve mobility, especially in the early stages of the condition.
  • Physical Therapy - Physical therapy involves exercises aimed at restoring the shoulder's range of motion. Stretching exercises can help improve flexibility and strength.
  • Heat and Cold Therapy - Applying heat or cold to the shoulder can help reduce pain and swelling. This might include ice packs, heat pads, or alternating between the two.
  • Transcutaneous Electrical Nerve Stimulation (TENS) - A TENS unit uses a mild electrical current to help relieve pain by blocking nerve signals.

Surgical Treatment Options

Surgical intervention for frozen shoulder is considered when non-surgical treatments have not provided sufficient relief.

  • Shoulder Arthroscopy
    In this minimally invasive procedure, small incisions are made around the shoulder, and a tiny camera (arthroscope) is inserted to guide the surgeon. The surgeon then uses small instruments to remove the scar tissue and release the tight joint capsule.
  • Manipulation Under Anaesthesia (MUA)
    This procedure involves putting the patient under general anaesthesia, after which the doctor moves the shoulder joint in various directions to loosen the tightness of the capsule.
  • Capsular Release
    This surgical procedure involves cutting through the tight portions of the joint capsule. It can be performed arthroscopically or through a more traditional open surgery, depending on the case.

Prevention Strategies

While it may not be possible to prevent frozen shoulder in every case, certain strategies can reduce the risk or lessen the severity of the condition.


  • Regular Exercise: Engaging in activities that maintain shoulder mobility and strength, particularly after an injury or surgery, can help prevent stiffness.
  • Managing Chronic Conditions: Effective control of conditions like diabetes and thyroid disorders can reduce the risk of developing a frozen shoulder.
  • Early Intervention: Seeking early treatment for shoulder pain or stiffness can prevent the progression to a frozen shoulder.
  • Shoulder Stretches: Incorporating shoulder stretching exercises into a daily routine, especially for those at higher risk, can maintain flexibility.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    What is the typical duration of frozen shoulder?

    The duration varies, but typically it lasts from 1 to 3 years. The condition goes through three stages: freezing, frozen, and thawing, each varying in length.

    Can frozen shoulder recur?

    While it’s rare for frozen shoulder to recur in the same shoulder, the opposite shoulder can be affected in up to 20% of individuals.

    Is surgery always necessary for frozen shoulder?

    No, surgery is not always necessary. Many cases improve with non-surgical treatments like physical therapy, medication, and home exercises.

    Are there any activities I should avoid with frozen shoulder?

    Activities that involve heavy lifting or extensive shoulder movements may aggravate the condition. Modify activities to avoid further shoulder strain.

    Is frozen shoulder linked to any specific medical conditions?

    Yes, conditions such as diabetes, thyroid disorders, and certain cardiovascular diseases are associated with a higher risk of developing frozen shoulder.