Frozen shoulder, also known as adhesive capsulitis, is characterized by stiffness and pain in the shoulder joint. It develops when the connective tissue surrounding the shoulder joint thickens and tightens, restricting movement. If left untreated, a frozen shoulder can significantly impact daily activities and quality of life. This article explores the causes, symptoms, and treatment approaches for frozen shoulder to help patients understand how to manage and recover from this condition.

What Is Frozen Shoulder?

Frozen shoulder involves the thickening and contraction of the shoulder’s joint capsule, the connective tissue that encases the shoulder joint. As the capsule tightens, adhesions (bands of scar tissue) form, limiting the joint’s range of motion. The condition progresses through three distinct stages:

1. Freezing Stage: Gradual onset of shoulder pain, leading to increased stiffness. The pain may worsen at night and disrupt sleep. This stage can last from 6 weeks to 9 months.
2. Frozen Stage: Pain may decrease, but stiffness and limited range of motion persist. Daily activities become challenging. This stage can last from 4 to 12 months.
3. Thawing Stage: The shoulder gradually regains mobility, and stiffness decreases. Full or near-full recovery may take several months to 2 years.

Causes and Risk Factors of Frozen Shoulder

While the exact cause of a frozen shoulder is not fully understood, several factors and conditions are associated with an increased risk:

1. Immobilization

A leading risk factor is shoulder immobilization due to injury, surgery, or prolonged disuse. When the shoulder is kept in a fixed position for an extended period, it can develop adhesions and tighten the joint capsule.

2. Diabetes

Frozen shoulder is more common in individuals with diabetes, particularly those with type 1 diabetes. The exact reason is unclear, but it is believed that elevated blood sugar levels may affect connective tissue health, increasing the likelihood of developing a frozen shoulder.

3. Other Medical Conditions

Certain medical conditions, such as hypothyroidism, hyperthyroidism, cardiovascular disease, and Parkinson’s disease, have been linked to an increased risk of frozen shoulder.

4. Age and Gender

Frozen shoulder most commonly affects individuals between the ages of 40 and 60, and it is more prevalent in women than men.

5. Injury or Surgery

Shoulder injuries, such as fractures, rotator cuff tears, or surgeries like mastectomy, can trigger the development of a frozen shoulder, especially if the shoulder remains immobile during recovery.

Symptoms of Frozen Shoulder

The symptoms of a frozen shoulder develop gradually and vary depending on the stage of the condition:

• Pain: A dull, aching pain that may worsen with shoulder movement. Pain is often felt in the outer shoulder area and sometimes down the arm.
• Stiffness: Limited range of motion, particularly when lifting the arm, reaching behind the back, or performing overhead movements.
• Difficulty with Daily Activities: As the shoulder stiffens, tasks like dressing, grooming, and reaching for objects become increasingly difficult.
• Sleep Disturbance: Pain often worsens at night, disrupting sleep.

Diagnosing Frozen Shoulder

A combination of physical examination and imaging studies is used to diagnose frozen shoulder:

1. Physical Examination

The doctor will assess the shoulder’s range of motion and check for pain, tenderness, and stiffness. They may perform specific movements, such as raising the arm or rotating it outward, to identify limitations in mobility.

2. Patient History

A thorough review of the patient’s medical history, including any previous shoulder injuries, surgeries, or underlying health conditions (e.g., diabetes), helps diagnose a frozen shoulder.

3. Imaging Studies

• X-rays: While X-rays cannot detect frozen shoulder, they can rule out other conditions, such as arthritis or fractures, that may contribute to shoulder pain.
• MRI or Ultrasound: Magnetic resonance imaging (MRI) or ultrasound can provide detailed images of the shoulder’s soft tissues, helping identify inflammation, thickening of the joint capsule, and other structural issues.

Treatment Approaches for Frozen Shoulder

The primary goals of treatment are to relieve pain, reduce stiffness, and restore shoulder mobility. Treatment options vary based on the stage and severity of the condition.

1. Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation.
• Steroid Injections: Corticosteroid injections directly into the shoulder joint can relieve inflammation and pain, particularly during the freezing stage.

2. Physical Therapy

Physical therapy is a crucial component of frozen shoulder treatment. A physical therapist designs an individualized exercise program to improve the range of motion, strengthen the shoulder muscles, and reduce stiffness. Techniques may include:

• Stretching: Gentle stretching exercises to gradually increase flexibility and mobility in the shoulder joint.
• Joint Mobilization: The physical therapist performs Manual therapy techniques to enhance joint mobility and break down adhesions.
• Heat Therapy: Applying heat before exercises to relax the muscles and facilitate movement.

3. Home Exercises

Patients are encouraged to perform prescribed home exercises regularly to maintain the progress achieved in physical therapy. Consistent practice of stretching and range-of-motion exercises is vital for long-term improvement.

4. Ice Therapy

Applying ice packs to the shoulder for 15-20 minutes several times daily can help reduce inflammation and numb pain, particularly during the early stages.

5. Surgical Intervention

Surgery is considered when conservative treatments fail to provide relief after several months. Surgical options include:

• Manipulation Under Anesthesia (MUA): The patient is placed under anesthesia, and the surgeon gently manipulates the shoulder to break up adhesions and improve mobility.
• Arthroscopic Capsular Release: A minimally invasive procedure in which the surgeon uses small incisions and an arthroscope to release the tight joint capsule, allowing for an increased range of motion.

Preventing Frozen Shoulder

• Early Mobilization: After shoulder injuries or surgeries, begin gentle shoulder movements as soon as possible under the guidance of a healthcare professional to prevent stiffness and adhesions.
• Regular Exercise: Incorporate shoulder-strengthening and stretching exercises into your routine to maintain flexibility and joint health.

Conclusion

Frozen shoulder is a condition that can significantly impact daily activities due to pain and stiffness. Early diagnosis and a comprehensive treatment plan, including medications, physical therapy, and home exercises, are essential for managing symptoms and restoring shoulder mobility. If conservative treatments are not effective, surgical intervention may be necessary. Consult an orthopedic specialist for persistent shoulder stiffness and pain to discuss appropriate treatment options.