Conditions

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by stiffness, pain, and limited range of motion in the shoulder joint. It occurs when the capsule surrounding the shoulder joint thickens and tightens, restricting movement and causing discomfort. Treatment is crucial to alleviate symptoms, improve shoulder mobility, and prevent long-term disability.

What Is Frozen Shoulder, And Why Is Treatment Important?

A frozen shoulder is characterised by stiffness, pain, and a limited range of motion in the shoulder joint. It typically progresses through three stages – freezing, frozen, and thawing. During the freezing stage, those experience gradually increasing shoulder pain and stiffness. In the frozen stage, shoulder movement becomes severely restricted, making daily activities difficult. In the thawing stage, symptoms gradually improve, and shoulder mobility returns. Treatment is important to relieve pain, restore shoulder function, and prevent further stiffness and disability.

What Are The Causes And Risk Factors Of Frozen Shoulder?

The exact cause of frozen shoulder is not fully understood, but several factors may contribute to its development, including:

Inflammation – Inflammation of the shoulder capsule can lead to thickening and tightening of the tissues, restricting movement.

Immobilisation – Prolonged immobilisation of the shoulder joint, such as after surgery, injury, or prolonged periods of inactivity, can increase the risk of developing a frozen shoulder.

Medical Conditions – Certain medical conditions such as diabetes, thyroid disorders, heart disease, and Parkinson’s disease may increase the risk of developing a frozen shoulder.

Age and Gender – Frozen shoulder is more common in individuals aged 40 to 60 years and is more prevalent in women than men.

Shoulder Trauma or Surgery – Previous shoulder injuries, trauma, or surgery can predispose individuals to develop adhesive capsulitis.

Other Factors – Factors such as genetics, hormonal changes, and autoimmune disorders may also play a role in the development of a frozen shoulder.

What Are The Common Symptoms Of Frozen Shoulder?

The symptoms of a frozen shoulder typically develop gradually and may include the following:

Shoulder Pain – Dull, aching pain in the shoulder joint, often worsening at night or with movement.

Stiffness – Progressive stiffness and limited range of motion in the shoulder joint, making it difficult to perform daily activities such as reaching overhead or behind the back.

Difficulty Sleeping – Shoulder pain and stiffness may interfere with sleep, particularly when lying on the affected side.

Painful Movements – Pain or discomfort with certain shoulder movements, especially reaching, lifting, or rotating the arm.

Loss of Function – Difficulty performing tasks that require shoulder movement, such as dressing, combing hair, or reaching for objects.

Gradual Onset – Symptoms typically develop gradually over weeks to months, progressing through stages of increasing pain and stiffness.

How Is Frozen Shoulder Diagnosed?

Diagnosing frozen shoulder typically involves a clinical examination and may include various diagnostic tests to confirm the condition. Here’s how frozen shoulder is diagnosed through clinical examination and the common diagnostic tests used to confirm it:

Clinical Examination

Medical History – The doctor will review your medical history, including symptoms, onset of pain or stiffness, any previous injuries or surgeries involving the shoulder, and any underlying medical conditions.

Physical Examination – A thorough physical examination of the affected shoulder will be conducted. This may involve:

Palpation
Range of Motion (ROM) Assessment
Muscle Strength Testing Provocative Tests Functional Assessment

Diagnostic Tests

X-rays
MRI (Magnetic Resonance Imaging)
Ultrasound
Arthroscopy

What Are The Frozen Shoulder Treatment Options?

Treatment options for frozen shoulder, also known as adhesive capsulitis, depend on the severity of symptoms, the stage of the condition, and individual factors such as age, activity level, and overall health. Here are the main frozen shoulder treatment options:

Pain Management

Over-the-counter or prescription pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, may be used to help alleviate pain associated with frozen shoulder.

Rest and Activity Modification

Resting the affected shoulder and avoiding activities that exacerbate symptoms can help reduce inflammation and prevent further aggravation of the condition.

Physical Therapy

Physical therapy may be recommended to help improve shoulder range of motion, reduce stiffness, and alleviate pain associated with frozen shoulder. Therapists may use stretching, manual therapy, and specific exercises to target the affected shoulder and surrounding muscles.

Heat and Cold Therapy

Applying heat or cold packs to the affected shoulder may help reduce pain and inflammation, improve blood flow, and promote healing.

Joint Mobilization Techniques

Gentle joint mobilisation techniques performed by a qualified healthcare provider may help improve shoulder mobility and reduce stiffness associated with frozen shoulder.

Steroid Injections

Injections of corticosteroids into the shoulder joint may be recommended to reduce inflammation and alleviate pain associated with frozen shoulder. Steroid injections are typically used for short-term pain relief and may be repeated periodically if needed.

Hydrodilatation (Hydrodilation)

Hydrodilatation involves injecting a mixture of saline solution and corticosteroids into the shoulder joint to help stretch the capsule and improve shoulder mobility. Hydrodilatation may be considered in cases of severe or persistent frozen shoulder that do not respond to conservative treatments.

Manipulation Under Anesthesia (MUA)

MUA involves manipulating the shoulder joint while the patient is under anaesthesia to break up adhesions and scar tissue and improve shoulder mobility. MUA may be considered in cases of severe frozen shoulder that do not respond to conservative treatments.

Surgical Intervention

Arthroscopic Capsular Release – During arthroscopic surgery, the surgeon cuts through the tight capsule surrounding the shoulder joint to improve mobility and reduce pain.
Open Capsular Release – In cases of severe adhesive capsulitis, open surgery may be performed to release the tight capsule and improve shoulder mobility.

Recovery And Prevention Strategies For Frozen Shoulder

Recovery and prevention strategies for frozen shoulders aim to reduce pain, improve flexibility, and restore normal shoulder function. Here are some strategies:

For Recovery:

Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help alleviate pain and reduce inflammation associated with frozen shoulder. In some cases, prescription medications or corticosteroid injections may be necessary for pain management.
A physical therapist can design a customised rehabilitation program to improve the range of motion, strengthen the muscles surrounding the shoulder joint, and alleviate pain. Treatment may include gentle stretching exercises, manual therapy techniques, and modalities such as heat or ultrasound therapy.
Perform gentle stretching exercises for the shoulder joint to improve flexibility and range of motion. Focus on stretching exercises that target the muscles and connective tissues surrounding the shoulder joint, such as internal and external rotation stretches.
Hands-on techniques such as joint mobilisation or manipulation performed by a physical therapist or chiropractor can help improve shoulder mobility and reduce stiffness. These techniques involve applying gentle pressure or movement to the affected joint to restore normal function.
Heat therapy, such as a heating pad or warm compress, can help relax muscles and improve blood flow to the affected area, reducing pain and stiffness. Cold therapy, such as applying ice packs, can help reduce inflammation and numb pain. Alternate between heat and cold therapy for 15-20 minutes each, several times daily.
To avoid further irritation or injury to the shoulder joint, modify activities or movements that exacerbate symptoms of frozen shoulder. Avoid activities that require overhead reaching or repetitive shoulder movements until symptoms improve.
In severe cases where conservative treatments fail to provide relief, surgical intervention may be necessary to release the tight capsule surrounding the shoulder joint. Surgical options may include manipulation under anaesthesia or arthroscopic capsular release.

For Prevention:

Incorporate regular shoulder range of motion exercises into your daily routine to maintain flexibility and prevent stiffness in the shoulder joint. Perform gentle stretching exercises for the shoulders, neck, and upper back to improve mobility and reduce the risk of frozen shoulder.
Strengthen the muscles surrounding the shoulder joint, including the rotator cuff muscles, deltoids, and scapular stabilisers, to provide support and stability. Use resistance bands or light weights to perform strengthening exercises for the shoulders and upper body.
Maintain good posture habits, such as sitting and standing up straight with your shoulders back and spine aligned. Avoid slouching or hunching over, particularly when sitting for extended periods.
Avoid repetitive or overhead shoulder movements that can strain the shoulder joint and increase the risk of developing a frozen shoulder. Take breaks or alternate tasks to prevent overuse injuries.
Always perform a thorough warm-up before engaging in activities that require shoulder movement to prepare the muscles and tendons for activity. Likewise, cool down and stretch after activity to prevent stiffness and reduce the risk of injury.
Maintain a healthy lifestyle by eating a balanced diet, staying hydrated, exercising regularly, and managing stress. These factors can contribute to overall shoulder health and reduce the risk of developing frozen shoulder.
Schedule regular check-ups with a healthcare professional to monitor shoulder health and address any underlying issues that may contribute to the development of frozen shoulder. Early detection and intervention can help prevent progression and improve treatment outcomes.

Implementing these recovery and prevention strategies can effectively manage frozen shoulder, alleviate symptoms, and reduce the risk of recurrence. Working closely with healthcare professionals, such as orthopaedic professionals, physical therapists, or chiropractors, is essential to developing a personalised treatment and prevention plan based on individual needs and circumstances.

Dr Lee is an experienced orthopaedic surgeon who specializes in

Frozen Shoulder

He will assess your condition and advise the best form of treatment for your condition. With proper treatment, patients can look forward to a full and quick recovery without complications.

Dr Lee Eu Jin

CONSULTANT ORTHOPAEDIC SURGEON
JOINT REPLACEMENT SPECIALIST AND SPORTS SURGEON

MBBS (London), MRCS (Edin),
M.Med (Orth), FRCS (Orth & Trauma)

Dr Lee Eu Jin is a Consultant Orthopaedic Surgeon with a subspecialty interest in hip and knee surgery.