Frozen Shoulder

Frozen shoulder, medically termed adhesive capsulitis, is characterised by stiffness and discomfort in the shoulder joint. This condition typically progresses gradually and may endure for an extended duration. In this article, we will explore the origins, signs, diagnostic methods, therapeutic approaches, and preventive measures associated with frozen shoulders.

Anatomy

The shoulder is a ball-and-socket joint composed of three bones:

• The humerus (the bone of the upper arm)
• The scapula (the shoulder blade)
• The clavicle (the collarbone)

The head of the upper arm bone sits within a shallow socket in the shoulder blade. This joint is surrounded by strong connective tissue known as the shoulder capsule.

To facilitate smooth movement, synovial fluid lubricates both the shoulder capsule and the joint itself.

What is a Frozen Shoulder?

Frozen shoulder is a medical condition marked by stiffness and pain within the shoulder joint. Its onset involves the thickening and tightening of the connective tissue capsule encasing the shoulder joint, thereby impeding its natural range of motion. Frozen shoulder disease typically develops slowly and can be divided into three stages:

• Freezing Stage: Pain and stiffness in the shoulder joint, which gradually worsens over time. It may last for a few weeks to months.
• Frozen Stage: Pain may lessen, but the shoulder becomes stiffer and more difficult to move. This stage can persist for 4-6 months or longer. Everyday activity becomes increasingly challenging.
• Thawing Stage: The range of motion accessible by the shoulder begins to improve. This stage can take months to years. The shoulder slowly regains flexibility and recovers movement.

Symptoms of Frozen Shoulder

The symptoms of frozen shoulders can vary, based on the stage of the condition. Some prevalent symptoms include:

• Pain and stiffness within the shoulder joint, are particularly noticeable with a gradual onset of pain.
• Restricted range of motion in the shoulder.
• Disrupted sleep patterns due to pain and discomfort.
• Increased pain intensity during night time.

Causes of Frozen Shoulder

The exact origin of frozen shoulders remains unknown. Nevertheless, specific factors increase the likelihood of developing this condition, including:

• Age and Gender: Individuals aged 40 and above, especially women, face an increased susceptibility to frozen shoulders.
• Immobility or Reduced Mobility: Those compelled to maintain shoulder immobility for extended durations, such as post-surgery or after an arm fracture, are at greater risk.
• Systemic Diseases: Individuals with certain conditions like diabetes, cardiovascular disease, or Parkinson’s disease are predisposed to developing frozen shoulders.
• Previous Shoulder Injuries: People with a previous history of shoulder trauma also have a higher tendency to develop frozen shoulders.

Frozen Shoulder Diagnosis

To diagnose a frozen shoulder, your doctor will perform a physical exam and review your medical history. They would question the symptoms and check the range of mobility as well. They may also order diagnostic tests, such as X-rays or an MRI to rule out other conditions.

To diagnose frozen shoulder (adhesive capsulitis), your healthcare provider will start by talking to you about your symptoms and going over your medical history. They’ll then examine your arms and shoulders, which includes:

Moving Your Shoulder: They’ll move your shoulder in different directions to see how well it moves and whether it causes you any pain. This is known as checking your “passive range of motion,” where they move your arm for you.

• Observing Your Shoulder Movement: They’ll also watch you move your shoulder on your own to assess your “active range of motion.”
• Comparing Both Movements: They’ll compare how much you can move your shoulder yourself with how much they can move it. If you have frozen shoulder, both types of movement will be limited.
• Your provider might also order shoulder X-rays to rule out other possible causes, like arthritis. Usually, you won’t need more advanced imaging tests like an MRI or ultrasound to diagnose frozen shoulder, but your provider might suggest them to check for other issues, such as a rotator cuff tear.

Frozen Shoulder Treatment

The treatment for frozen shoulders typically involves a combination of physical therapy and pain management. Some common treatments include:

• Range-of-Motion Exercises: These exercises help improve the shoulder’s range of motion and reduce stiffness. They are either done under the guidance of a physical therapist or with instructions to be performed at home.
• Heat and Ice Packs: One of the tried and tested age-old remedies for any sort of inflammation also works in the case of a frozen shoulder. For best results, heat and ice packs need to be placed alternatively to form a natural treatment for frozen shoulders.
• Pain Relievers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen can help reduce pain and inflammation.
• Corticosteroid Injections: These injections can help reduce pain and inflammation in the shoulder joint.
• Numbing Medications: These medications can be injected into the shoulder joint to help reduce pain and improve mobility.
• Surgery: In rare cases, surgery may be necessary to loosen the joint capsule and improve mobility.

Surgical Treatment

Surgical treatment of a frozen shoulder is typically considered when conservative measures, such as physical therapy and medications, have failed to provide relief over an extended period of time, usually around 6 to 12 months. Surgical options for frozen shoulder include:

• Arthroscopic Capsular Release: This is the most common surgical procedure for a frozen shoulder. It involves making small incisions around the shoulder and using a tiny camera (arthroscope) and specialized instruments to cut through tight and thickened joint capsule tissues. This helps to release the tightness and restore the range of motion in the shoulder.
• Manipulation Under Anesthesia (MUA): In this procedure, the patient is placed under anesthesia, and the surgeon forcefully moves the arm to break up scar tissue and adhesions that are limiting shoulder movement. This can be followed by arthroscopic capsular release to further improve range of motion.
• Open Capsular Release: In some cases, particularly when arthroscopic techniques are not feasible or effective, open surgery may be performed. This involves making a larger incision to directly access and release the tight capsule around the shoulder joint.

How long does rehabilitation take?

Supervised physical therapy for frozen shoulder usually lasts between one and six weeks, with sessions held one to three times a week. During this time, it's important for patients to do their home exercises and stretches regularly. These stretches should be done at least once or twice a day at home.

Usually, a frozen shoulder improves significantly over time with consistent treatment. Recovery can take anywhere from six to nine months for some people, but it might be quicker for others. Regaining internal rotation, like reaching your hand to your back pocket or up the middle of your back, is often the most challenging and time-consuming part of the recovery.

How to Cure Frozen Shoulders Quickly?

There is no quick cure for a frozen shoulder. However, a faster diagnosis can help prevent the condition from worsening. If you are experiencing symptoms of a frozen shoulder, it is important to seek medical attention promptly. However, there are a few things one can do to ensure faster recovery:

• Stay active: Try to maintain a minimum level of activity despite the discomfort. This includes gentle stretches and exercises.
• Warm Compress: As mentioned before, heat packs and ice packs are one of the easiest remedies.
• Stay Hydrated: Make sure you're drinking enough water throughout the day. Staying hydrated helps your body function better and can reduce muscle cramps and stiffness. Aim for 6-8 glasses of water daily.
• Get Enough Rest: Rest is essential for recovery. Make sure you’re getting enough sleep at night to allow your body to heal and rejuvenate. Try to maintain a regular sleep schedule and create a relaxing bedtime routine.
• Eat a Balanced Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains supports overall health. Certain foods, like those high in omega-3 fatty acids (e.g., fish, nuts), have anti-inflammatory properties that can help reduce discomfort.

Risk Factors

Certain factors can increase the risk of developing frozen shoulders, including:

• Age: Frozen shoulder typically affects people between the ages of 40 and 60, with the risk increasing with age.
• Gender: Women are more likely to develop frozen shoulder than men.
• Previous injury or surgery: Any injury or surgery to the shoulder that leads to prolonged immobility or reduced use can increase the risk of developing frozen shoulder.
• Medical conditions: Certain health issues like diabetes, thyroid problems, heart disease, Parkinson's, and Dupuytren's contracture can raise your chances of getting frozen shoulder. These conditions might cause swelling and changes in your shoulder joint.
• Immobility or reduced mobility: Immobilization of the shoulder joint due to factors such as injury, surgery, or prolonged periods of inactivity can lead to the development of frozen shoulder.
• Systemic diseases: Conditions like lupus, rheumatoid arthritis, and others that affect your whole body can also affect your shoulder joint and lead to frozen shoulder.
• Genetics: There may be a genetic predisposition to developing frozen shoulder, although more research is needed to understand the specific genetic factors involved.
• Occupational factors: Certain occupations or activities that involve repetitive overhead arm movements or heavy lifting may increase the risk of shoulder injuries, which can contribute to the development of frozen shoulder over time.
• Psychological factors: Stress and depression can worsen chronic pain conditions, including frozen shoulder, by making you more sensitive to pain and making symptoms last longer.

Prevention

While absolute prevention may not be completely in our hands, one can take precautionary measures like:

• Maintaining mobility: Regular exercise and maintaining fitness ensure shoulder flexibility.
• Systemic diseases: Control of some lifestyle diseases like diabetes can greatly help in avoiding frozen shoulders.
• Gradual exercise: While exercise is good, one should avoid sudden stress or strenuous exercise without prior practice.

When to Consult a Physician?

Should you encounter indications of frozen shoulder, such as shoulder joint pain and stiffness, disrupted sleep, or heightened nighttime pain, it is crucial to promptly seek medical assistance. Timely intervention facilitates early diagnosis and treatment, potentially curbing the progression of the condition.

Who is at risk for frozen shoulders?

Frozen shoulder can happen to anyone, but some people are more likely to get it:

• People Aged 40-60: It’s more common in people who are between 40 and 60 years old.
• Women: Women are more likely to develop frozen shoulder than men.
• People with Diabetes: If you have diabetes, you’re at a higher risk.
• People with Certain Health Conditions: Conditions like thyroid problems, heart disease, and Parkinson’s disease can increase your chances of getting frozen shoulder.
• People Who Don’t Move Their Shoulder Much: If you’ve been less active or kept your shoulder still for a long time, you’re more likely to develop a frozen shoulder.

Conclusion

Frozen shoulder, characterised by stiffness and pain in the shoulder joint, generally evolves gradually and may persist for an extended period. Combining physical therapy and pain management is often effective in treating this condition. If you observe symptoms indicative of frozen shoulder, it is imperative to promptly consult with a healthcare professional for appropriate guidance and care.

FAQs

1. Who is at risk for developing a frozen shoulder?

Ans: People over the age of 40, particularly women, are more likely to develop frozen shoulders. People who have had to keep their shoulder still for a long period of time, such as after surgery or an arm fracture, are also at higher risk of developing frozen shoulders.

2. Is frozen shoulder serious?

Ans: Frozen shoulder is not usually a severe condition, but it can be very painful and may last for several years if left untreated. If your frozen shoulder is interfering with everyday tasks or causing too much pain, it is time to visit a specialist and begin treatment.

3. Is heat good for a frozen shoulder?

Ans: Heat can help reduce pain and stiffness in the shoulder joint. Applying a warm compress or taking a warm shower can improve mobility and reduce discomfort.

4. How do you sleep with a frozen shoulder?

Ans: Find a comfortable position that does not apply undue pressure to the affected side. You can also use a pillow to support the arms and shoulder or try sleeping in a recliner.

5. Is frozen shoulder common in diabetic patients?

Ans: Yes, frozen shoulder, also known as adhesive capsulitis, is more common in diabetic patients compared to the general population. Diabetes increases the risk of developing frozen shoulder.

6. Will the frozen shoulder heal on its own?

Ans: Frozen shoulder can improve over time, but it often requires treatment to relieve symptoms and restore full range of motion. Without treatment, it may take months to years to resolve on its own.

7. Can frozen shoulder cause chest pain?

Ans: Frozen shoulder typically does not directly cause chest pain. However, individuals with frozen shoulder may alter their posture or movement patterns, which could potentially lead to muscle strain or discomfort in the chest area. If experiencing chest pain, it's crucial to seek medical evaluation to rule out other causes.

8. Which doctor should I consult for a frozen shoulder?

Ans: Orthopedic surgeons, rheumatologists, or physical medicine and rehabilitation specialists are healthcare professionals who commonly treat frozen shoulder. Consulting with a primary care physician can also be a good starting point for evaluation and referral.

9. Can massage help with a frozen shoulder?

Ans: Massage therapy can provide temporary relief from frozen shoulder symptoms by promoting relaxation and reducing muscle tension. However, it's essential to consult with a healthcare professional before starting any massage therapy to ensure it's safe and appropriate for your condition. In some cases, specific physical therapy exercises may be more beneficial for improving the range of motion and function in the shoulder.

10. What is the root cause of frozen shoulder? 

Ans: A frozen shoulder occurs when the connective tissue around the shoulder joint becomes thickened and tight, limiting movement and causing pain. The exact cause isn’t always clear, but it can be linked to shoulder injuries, surgery, or certain health conditions like diabetes.

11. How to recover fast from a frozen shoulder? 

Ans: To speed up recovery, it’s important to follow a consistent treatment plan, which includes physical therapy and stretching exercises. Regularly doing the exercises recommended by your healthcare provider can help improve your shoulder's movement. Staying active and managing any underlying health conditions also supports quicker recovery.

12. Is it okay to massage a frozen shoulder? 

Ans: Gentle massage can be helpful for relieving muscle tension and improving circulation around a frozen shoulder. However, it's important to avoid aggressive or painful massage techniques. Always consult with your healthcare provider before starting any new treatment, including massage.

13. What happens if a frozen shoulder is not treated? 

Ans: If a frozen shoulder is left untreated, it can lead to prolonged stiffness and pain, making it difficult to use the affected shoulder. The condition may eventually improve on its own, but treatment can help speed up recovery and reduce discomfort.

CARE Medical Team