About Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin slowly, then get worse. Over time, symptoms get better, usually within 1 to 3 years.

Having to keep a shoulder still for a long period increases the risk of developing a frozen shoulder. This might happen after having surgery or breaking an arm.

Treatment for frozen shoulders involves range-of-motion exercises. Sometimes treatment involves corticosteroids and numbing medications injected into the joint. Rarely, arthroscopic surgery is needed to loosen the joint capsule so that it can move more freely.

It's unusual for frozen shoulders to recur in the same shoulder. But some people can develop it on the other shoulder, usually within five years.

Types of Frozen Shoulder

• Primary Frozen Shoulder: Develops spontaneously without a clear cause. The underlying reason is unknown.
• Secondary Frozen Shoulder: Occurs due to a known event or condition, such as shoulder injury, surgery, or prolonged immobilization

Signs and Symptoms of Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by progressive stiffness, pain, and limited range of motion in the shoulder joint. Symptoms typically develop gradually and may worsen over time. Common signs and symptoms include:

• Persistent, dull or aching pain located in the outer shoulder or upper arm, which may become more pronounced with movement or at night, especially when lying on the affected side.
• Progressive stiffness that affects both active (self-initiated) and passive (when someone else moves your arm) shoulder movements.
• Decreased range of motion, making it difficult to perform everyday activities such as combing your hair, reaching behind your back, or putting on clothes.
• Increased difficulty with overhead movements, like reaching for items on a high shelf.

Symptom Progression: The Three Stages

Frozen shoulder typically follows a well-defined course, progressing through three distinct stages:

1. Freezing Stage (Lasts 6 weeks to 9 months)
   
   • Pain gradually worsens and becomes more constant, particularly with movement.
   • Shoulder motion starts to become limited.
   • Activities of daily living become increasingly difficult due to discomfort and restricted movement.
2. Frozen Stage (Lasts 4 to 6 months)
   
   • Pain may begin to subside, especially at rest.
   • However, the shoulder becomes stiffer and range of motion is significantly restricted.
   • Daily tasks remain challenging, often due to the severity of stiffness rather than pain.
3. Thawing Stage (Lasts 6 months to 2 years)
   
   • Gradual return of shoulder movement.
   • Stiffness slowly decreases, and function improves over time.
   • Full recovery is possible, though in some cases mild stiffness may persist.

Frozen Shoulder Causes

The exact cause is not fully understood, but it involves inflammation and thickening of the shoulder capsule. Known risk factors include:

• Prolonged immobilization or lack of shoulder use after injury or surgery
• Diabetes mellitus (higher incidence and more severe stiffness)
• Thyroid disorders (both hypo- and hyperthyroidism)
• Parkinson’s disease, cardiac disease, and other systemic illnesses
• Age (most common between 40 and 60 years)
• Female gender (about 70% of cases)

Risk Factors for Frozen Shoulder

Certain individuals are more likely to develop frozen shoulders due to underlying health conditions, age, or other contributing factors. Recognizing these risk factors can help in early identification and prevention:

• Diabetes: People with diabetes—both Type 1 and Type 2—are at a significantly higher risk of developing frozen shoulders. Studies suggest they are up to five times more likely to be affected. The exact cause is unclear, but it may be related to changes in collagen and inflammation associated with high blood sugar levels.
• Thyroid disorders: Conditions like hypothyroidism or hyperthyroidism can disrupt the body’s hormonal balance, which may contribute to inflammation and tissue changes in the shoulder joint.
• Previous shoulder injury or surgery: Any event that leads to prolonged immobilization of the shoulder—such as a fracture, rotator cuff injury, or post-surgical recovery—can increase the risk. Lack of movement over time may trigger the development of adhesive capsulitis.
• Age (40 to 60 years): Frozen shoulder most commonly affects individuals between the ages of 40 and 60. It is rare in younger people unless linked to injury or underlying medical conditions.
• Female sex: Women are more frequently affected than men, though the reason for this sex difference is not fully understood. Hormonal factors may play a role.
• Systemic diseases: Certain chronic health conditions, including Parkinson’s disease, cardiovascular disease, and autoimmune conditions, have been associated with a higher risk. These diseases may influence shoulder mobility and tissue health either directly or indirectly.

Complications of Frozen Shoulder

If a frozen shoulder is left untreated or inadequately managed, it can lead to a number of long-term complications that may significantly impact a person's quality of life. These complications include:

• Persistent loss of shoulder mobility: The shoulder joint may remain stiff and restricted in its range of motion, even after the pain subsides. This limitation can become permanent in some cases, especially without appropriate therapy or intervention.
• Chronic pain: While pain often improves in the later stages, some individuals may continue to experience long-term discomfort or intermittent flare-ups. This pain can be particularly troublesome during certain movements or while sleeping.
• Muscle weakness and atrophy: Due to decreased use of the shoulder and surrounding muscles, there is a risk of muscle wasting (atrophy) and weakening. This is especially common in the rotator cuff and upper arm muscles, leading to further functional impairment.
• Difficulty performing daily activities: Basic tasks such as grooming, dressing, cooking, or reaching for objects can become frustrating or even impossible without assistance. This can affect personal independence and overall well-being.

Frozen Shoulder Diagnosis

Diagnosis is primarily clinical, based on history and physical examination showing limited active and passive range of motion in the shoulder. Imaging tests are used to exclude other conditions:

• X-rays to rule out arthritis or fractures
• MRI or ultrasound may be used to exclude rotator cuff tears or other soft tissue injuries but are not routinely required.

Frozen Shoulder Treatment Management

Frozen shoulder treatment usually involves pain relief methods until the initial phase passes. You may need therapy or surgery to regain motion if it doesn’t return on its own.

Some simple adhesive capsulitis treatments include:

• Hot and cold compresses: These help reduce pain and swelling.
• Medicines that reduce pain and swelling: These include nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®). Your healthcare provider may prescribe other painkiller/anti-inflammatory drugs. You can manage more severe pain and swelling with steroid injections. Your provider will inject a corticosteroid, like cortisone, directly into your shoulder joint.
• Physical Therapy: A physical therapist can teach you stretching and range-of-motion exercises.
• Home Exercise Program: Your healthcare provider can show you exercises you can do at home.
• Transcutaneous electrical nerve stimulation (TENS): Use of a small, battery-operated device that reduces pain by blocking nerve impulses.

If these noninvasive treatments haven’t relieved your pain and shoulder stiffness after about a year, your provider may recommend other procedures. These include:

• Manipulation under anesthesia: During this surgery, you’ll be put to sleep and your provider will force movement of your shoulder. This will cause your joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in your range of motion.
• Shoulder arthroscopy: Your provider will cut through the tight parts of your joint capsule (capsular release). They’ll insert small, pencil-size instruments through small cuts (incisions) around your shoulder.

Note. Medication is only advisable under doctor's consideration.