Frozen Shoulder

The exact cause of frozen shoulder is not fully understood. However, there are some factors that increase your risk.

Risk factors for frozen shoulder

• Being older than 40 years
• Cardiovascular disease
• Endocrine disorders such as diabetes and thyroid problems
• Gender, with women more likely to develop frozen shoulder than men
• Parkinson's disease
• Stroke
• Trauma or injury such as a fracture
• Long periods of immobility or limited movement due to pain, or recovery from injury or surgery

Preventing frozen shoulder

Prevention of frozen shoulder is only possible if it is caused by an injury, by maintaining mobility and flexibility of the shoulder joint during recovery and beyond.

The most obvious symptoms of frozen shoulder are dull pain in the shoulder and shoulder muscles that wrap around the top of the arm. The pain may worsen at night, making it difficult to sleep. The tightness of the shoulder capsule also limits your range of movement.

Frozen shoulder usually resolves over 2 – 3 years, going through three distinct stages known as freezing, frozen, and thawing. Each of these stages can last for several months.

• Stage 1: Freezing

  The freezing stage is characterised by increasing pain with any movement causes pain and shoulder movement is limited. This stage normally lasts from 6 weeks to 9 months.

• Stage 2: Frozen

  During the frozen stage, the pain may lessen, but the stiffness remains. Your movement will be restricted. This stage generally lasts from 4 to 6 months

• Stage 3: Thawing

  In this final stage, the movement in the arm slowly improves. Pain may improve but recur from time to time. This stage can last between 6 months and 2 years.

Frozen shoulder is diagnosed using:

• Physical examination

  Your doctor will check your range of movement, passively (by moving your arms him/herself) and actively (by asking you to move your arms yourself). Observing how you move and how far you can move will allow your doctor to assess your condition.

• Imaging tests

  X-rays are usually recommended to rule out other conditions that may also cause shoulder pain, such as arthritis. Magnetic resonance imaging (MRI) and ultrasounds can reveal other problems such as rotator cuff tears.

Treatment for frozen shoulder aims to manage the pain and restore movement and strength in the shoulder joint.

Non-surgical options include:

• Hot and cold compresses

  Applying a hot or cold compress several times a day can help to reduce mild pain and discomfort.

• Medications to relieve pain and/or inflammation

  Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain and inflammation of the shoulder joint. Follow your doctor’s instructions on how and when to take these medications.

• Hydrodilatation

  This involves injecting a large volume of sterile fluid into the shoulder joint, to expand and stretch the shoulder joint capsule.

• Steroid injections

  A corticosteroid such as cortisone can be injected directly into the joint to relieve severe pain and swelling.

• Physiotherapy and home-based exercises

  A physiotherapist can advise you on suitable exercises to improve your range of motion, which you can also practice at home. This may include exercises such as an external rotation passive stretch, a forward flexion in supine position and crossover arm stretch.

• Transcutaneous electrical nerve stimulation (TENS)

  Transcutaneous electrical nerve stimulation is a treatment method using low-voltage electrical currents to relieve pain. This electrical impulse is delivered using a small, battery-powered device, through electrodes placed at the shoulder joint.

Surgical options include:

• Manipulation under anaesthesia

  During this procedure, you will remain unconscious while the doctor forces your shoulder to move past its limited range. This will involve stretching or even tearing the tissues of the joint capsule to release the tightness and increase your range of motion.

• Shoulder arthroscopy

  In a shoulder arthroscopy, incisions will be made around your shoulder. This will allow your doctor to insert small surgical tools which will be used to cut through the tight tissues of the joint capsule. This is called a capsular release.

If surgery is performed, recovery time can very from 6 weeks to 3 months. Physiotherapy will be necessary to maintain and improve your range of motion. Long-term outcomes are generally good, with most patients having reduced pain and better range of motion.

If you have frozen shoulder that is affecting your daily activities, it is advisable to seek medical advice for diagnosis and appropriate treatment.

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Complication of frozen shoulder include:

• Residual stiffness or pain

  Some individuals may experience continued stiffness or pain that can linger for up to 3 years after non-surgical treatment.

• Bone or tissue damage

  Shoulder manipulation may sometimes result in fracture of the humerus, or rupture of the bicep or subscapularis tendon.

• Recurrence of frozen shoulder

  While rare, frozen shoulder can happen again. This is more common if the cause of the frozen shoulder is linked to a chronic condition like diabetes.