Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder, clinically known as adhesive capsulitis, is a condition marked by stiffness and pain in the shoulder joint. The shoulder joint is typically surrounded by a thin capsule. This condition arises when the capsule becomes inflamed, leading to pain and restricted movement.

The progression of frozen shoulder occurs in three distinct stages, each lasting from three to six months. While complete resolution is common, up to 15% of patients may experience ongoing restrictions in movement or weakness.

Stages of Frozen Shoulder

Frozen shoulder progresses through three stages, each with its characteristics and challenges.

Freezing Stage

This initial stage is characterised by a gradual onset of pain. As the stage progresses, the shoulder becomes increasingly stiff, leading to a noticeable decrease in the range of motion. The pain, often described as a dull ache, is usually worse during movement and can even disrupt sleep.

Frozen Stage

During the frozen stage, the pain may begin to subside, but the shoulder becomes much stiffer. The shoulder’s range of motion is limited, and activities that require lifting or rotating the arm become extremely challenging.

Thawing Stage

The final stage of frozen shoulder is marked by a gradual improvement in the range of motion. The pain diminishes further, and the shoulder starts to “loosen up.” This stage can be long but is generally indicative of recovery as the shoulder slowly returns to normal, or near-normal function.

Causes and Risk Factors

The development of frozen shoulder, while not fully understood, involves several key factors and conditions.

• Inflammation of the Shoulder Capsule: Frozen shoulder is caused by the inflammation of the thin capsule surrounding the shoulder joint. The precise cause of this is not entirely known. It is believed to involve auto-antibodies attacking the joint capsule, resulting in inflammation, adhesion, and scar tissue formation.
• Trauma to the Shoulder: Certain events can trigger the onset of frozen shoulder, including injury (such as during surgery).
• Diabetes: A correlation exists between diabetes and frozen shoulder, with diabetics being more prone to developing this condition.
• Age and Gender: Frozen shoulder most commonly affects individuals between 40 and 60 years of age and is more prevalent in women.
• Immobility or Reduced Mobility of the Shoulder: Prolonged immobility or reduced mobility of the shoulder, resulting from factors like rotator cuff injury, broken arm, stroke, or recovery from surgery, increases the risk of developing frozen shoulder.
• Certain Systemic Diseases: Certain systemic diseases raise the likelihood of experiencing frozen shoulder. These include diabetes, thyroid disorders (both hyperthyroidism and hypothyroidism), cardiovascular disease, tuberculosis, and Parkinson’s disease.

Non-Surgical Treatment Options

Various non-surgical treatments are available for managing frozen shoulder, focusing on pain relief and restoring motion.

Pain Management Medications

Non-steroidal anti-inflammatory medicines such as aspirin and ibuprofen can alleviate pain and reduce inflammation. In some cases, stronger pain-relieving and anti-inflammatory drugs may be prescribed.

Steroid Injections

Corticosteroids can be injected directly into the shoulder joint to decrease pain and improve mobility. This is especially effective if administered soon after symptoms begin.

Physiotherapy

Engaging in specific exercises under the guidance of a physiotherapist can help restore motion. This includes stretching or range-of-motion exercises, sometimes preceded by heat treatment to loosen the shoulder.

Surgical Treatment Options

In cases where non-surgical treatments do not provide adequate relief, surgical intervention may be considered for frozen shoulder.

• Manipulation under Anesthesia
  This procedure can be conducted to reduce the stiffness of the joint muscle. The patient is put under general anaesthesia, and while they are unconscious, the surgeon moves the shoulder joint in various directions. This action forces the capsule and scar tissue to stretch or tear, releasing the tightening and increasing the range of motion. It’s a less invasive option compared to direct surgical intervention, often providing immediate improvement in range of motion.
• Shoulder Arthroscopy
  In more severe cases, arthroscopic surgery might be necessary to reduce pain and improve range of motion. This involves making small incisions around the shoulder and using pencil-sized instruments, guided by a camera, to cut through tight portions of the joint capsule. The aim is to remove scar tissue from inside the shoulder joint, thus alleviating the stiffness and improving movement.

Prevention Strategies

Preventing frozen shoulder primarily involves addressing factors that increase the risk of its development.

• Keeping the Shoulder Mobile: Keep the shoulder joint mobile, especially after an injury or surgery. Prolonged immobility is a risk factor for frozen shoulder.
• Engaging in Regular Exercise: Engaging in regular shoulder exercises can help maintain joint mobility and prevent stiffness. These exercises do not need to be intense but should focus on a full range of shoulder movements.
• Managing Systemic Diseases: Proper management of systemic conditions like diabetes, thyroid disorders, and cardiovascular diseases can reduce the risk of developing frozen shoulder.