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Frozen Shoulder

The shoulder joint is enclosed by a tough capsule that is surrounded by muscles and tendons. A frozen shoulder occurs when this capsule thickens, tightens, and becomes inflamed, limiting movement. It can affect one or both shoulders.

Around 5 out of 100 people experience frozen shoulder in their lifetime. It is most prevalent between the ages of 40 and 70 and primarily affects women more than men. Some health issues also put one at risk.

Frozen Shoulder Symptoms

Frozen shoulder mainly causes two symptoms:

  • Pain. It develops gradually and can get severe with time. Pain is usually worse at night or when moving the shoulder.
  • Stiffness. This limits shoulder movement and makes daily tasks like dressing or driving difficult.

Stages of Frozen Shoulder

Frozen shoulder is sometimes divided into three stages, though they may overlap and differentiating them becomes even more difficult.

  1. Painful or ‘freezing’ phase. Shoulder pain begins and slowly worsens over time, lasting between two and nine months.
  2. Stiffness or ‘frozen’ phase. Pain may lessen, yet movement becomes more restricted, which affects daily activities. This stage can last four months to a year.
  3. Resolution or ‘thawing’ phase. Stiffness steadily improves and movement returns, even though full recovery may take 3 years or even more.

Most people recover within 18 months to 2 years, but for some, it takes longer. If you experience shoulder pain or stiffness, seek medical assistance instead of waiting for improvement.

Causes of Frozen Shoulder

The exact reason some people experience a frozen shoulder isn’t always clear. In some cases, there’s no obvious cause—this is called a primary (idiopathic) frozen shoulder.

When there is an underlying reason, it is referred to as a secondary frozen shoulder. It may result from a shoulder injury, like damage to the rotator cuff (the muscles and tendons in the shoulder). It can also develop if the shoulder remains immobile for a long period, mostly after surgery or a fracture.

In addition, certain medical conditions may increase the possibility of a frozen shoulder, though the exact link is unclear. They include diabetes, underactive or overactive thyroid, and heart disease or stroke.

Diagnosis

During a frozen shoulder diagnosis, your doctor or physiotherapist will want to know these:

  • How long they’ve lasted
  • When they occur
  • What worsens them
  • How they affect daily activities

Also, they will review your medical history to check for past injuries or conditions that might increase your risk.

Physical examination:

Your shoulder will be examined for tenderness and movement restrictions. Tests may include:

  • Passive movement: The physiotherapist moves your arm for you.
  • Active movement: You move your arm into different positions yourself.

These help assess whether your shoulder’s range of motion is limited. Let your provider know if any movements cause discomfort.

A key test for a frozen shoulder is passive external rotation, where your ability to rotate your arm outward is assessed.

An X-ray isn’t usually needed to detect a frozen shoulder but may be recommended to rule out related conditions.

Treatment for Frozen Shoulder

Frozen shoulder may improve on its own, although full recovery may take years. Treatment focuses on easing pain and restoring movement. Starting treatment earlier can help speed up recovery.

Available treatment options include:

Physiotherapy:

Physiotherapy plays a key role in frozen shoulder treatment. Your doctor may refer you to a physiotherapist, or you can see one privately. Initial treatment usually lasts 6 weeks but may continue if effective.

Physiotherapy may involve:

  • Exercises: A physiotherapist will guide you through exercises to engage in while at home to help you improve movement and reduce pain.
  • Manual therapy (mobilisation): The physiotherapist gently moves your shoulder in specific ways to ease stiffness and discomfort. This could help reinstate normal mobility.
  • Shortwave diathermy (SWD) or pulsed shortwave diathermy (PSWD): Radiofrequency heat is used to loosen tissues and reduce pain or stiffness.

Acupuncture:

Acupuncture is done by inserting thin needles into the skin, often around the frozen shoulder, to relieve pain. The needles may remain in place throughout the treatment session. In some cases, they are manually stimulated or activated using small electrical pulses.

Some physiotherapists offer this treatment, though evidence of its effectiveness for frozen shoulder is limited. Always consult before deciding to undergo the procedure.

Joint injection:

If pain is severe or doesn’t improve with other remedies, a steroid injection might be helpful. It can reduce pain and make physiotherapy more effective.

Hydrodilation:

This procedure involves injecting fluid (saline and local anaesthetic) into the shoulder joint under X-ray or ultrasound guidance. The fluid stretches the joint capsule to free the joint and improve mobility.

Surgery:

Most frozen shoulder cases improve with non-surgical treatments; however, surgery may be an option if symptoms persist. An orthopaedic surgeon (bones and joints specialist) will perform the procedure, which may include the following:

  • Shoulder manipulation under anaesthetic (MUA): The shoulder is moved in different positions while you’re under general anaesthetic to stretch or tear the constricted capsule. This helps enhance mobility.
  • Arthroscopic capsular release: The surgeon performs keyhole surgery (also called shoulder arthroscopy) under general anaesthetic to examine the shoulder joint. Using surgical tools, they carefully divide sections of the joint capsule. This procedure may be done alongside a MUA.

If surgery is recommended, your surgeon will explain the benefits, risks, and preparation steps.

Self-Help for Frozen Shoulder

There are several ways to manage a frozen shoulder alongside medical treatment:

  • Pain relief: Take non-prescription painkillers like paracetamol or ibuprofen. Always follow the instructions and ask a pharmacist if you are unsure.
  • Hot or cold packs: Applying heat or ice can help reduce swelling, stiffness, and discomfort.
  • TENS machine: This device employs electrical currents in order to stimulate nerves and relieve pain.
  • Support while resting: Use pillows to support your arm while sitting or sleeping. A pillow behind your back can also improve your sitting posture.
  • Keep moving: Try to use your arm as much as possible to maintain mobility, but avoid movements that increase pain.
  • Modify movements: If raising your arm hurts, keep your elbow bent and close to your body to reduce strain.

Preventing Frozen Shoulder

While a primary frozen shoulder cannot always be avoided, you can take steps to reduce the risk of a secondary frozen shoulder. This is especially the case if it’s linked to an injury or medical condition.

Ensure your shoulder remains mobile after injury or surgery. Also, follow your doctor or physiotherapist’s advice on using a sling and safely regaining movement.

For those with diabetes, keeping it under control may help lower the risk of developing a secondary frozen shoulder.

Bottom Line

A frozen shoulder can significantly impact daily life, making even simple tasks challenging. If rest and painkillers don’t provide relief, consult your GP. They may suggest physiotherapy or other non-invasive treatments to improve mobility. If symptoms persist, surgery may be an option. Your provider can guide you toward the best treatment plan for your recovery.

Book an appointment today to get the right treatment and start your journey to recovery.