Frozen Shoulder – Causes, Symptoms and Treatment
Frozen shoulder is a painful shoulder condition causing progressive stiffness and restricted movement. It often develops without a clear cause and can last 1 to 3 years.
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Frozen shoulder is a painful shoulder condition causing progressive stiffness and restricted movement. It often develops without a clear cause and can last 1 to 3 years.
What is Frozen Shoulder?
Frozen shoulder – medically known as adhesive capsulitis – is a condition in which the capsule surrounding the shoulder joint becomes inflamed, thickened, and scarred. This leads to significant shoulder pain and a progressive loss of shoulder movement. The condition most commonly affects people between the ages of 40 and 60, and is more prevalent in women than in men.
Causes
In many cases, frozen shoulder develops without an identifiable cause, referred to as idiopathic frozen shoulder. However, several risk factors and associated conditions have been identified:
- Diabetes mellitus: People with diabetes have a significantly higher risk of developing frozen shoulder.
- Immobilisation: Prolonged immobility of the shoulder following injury or surgery.
- Hormonal changes: Particularly during menopause, the condition occurs more frequently.
- Thyroid disorders: Both an overactive and underactive thyroid are considered risk factors.
- Previous shoulder problems: Such as rotator cuff tears, shoulder joint inflammation, or calcific tendinitis.
Symptoms
Frozen shoulder typically progresses through three distinct phases:
Phase 1 – Freezing Phase
This phase can last several months and is characterised by gradually worsening shoulder pain, especially at night. The range of motion in the shoulder begins to decline.
Phase 2 – Frozen Phase
Pain may slightly decrease, but stiffness and restricted movement reach their peak. Everyday tasks such as combing hair or lifting the arm become very difficult.
Phase 3 – Thawing Phase
Shoulder mobility gradually returns during this phase, which can take up to two years to complete.
Diagnosis
Frozen shoulder is primarily diagnosed through a thorough clinical examination and patient history. Additional investigations may include:
- Shoulder ultrasound: To assess the joint capsule and surrounding structures.
- MRI (Magnetic Resonance Imaging): Reveals thickening of the joint capsule and signs of inflammation.
- X-ray: To rule out other causes such as osteoarthritis or calcific deposits.
Treatment
Treatment of frozen shoulder focuses on relieving pain and restoring mobility. The approach depends on the current phase of the condition:
Conservative Treatment
- Physiotherapy: Targeted stretching and mobilisation exercises are the cornerstone of treatment.
- Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen help reduce pain and inflammation.
- Corticosteroid injections: Injecting corticosteroids into the shoulder joint can provide significant short-term pain relief.
- Heat and cold therapy: Used as supportive measures to manage pain.
Interventional and Surgical Treatment
- Hydrodilatation: Expansion of the joint capsule by injecting saline solution and corticosteroid under imaging guidance.
- Arthroscopic capsular release: A minimally invasive procedure to cut through scar tissue and adhesions in the joint capsule.
- Manipulation under anaesthesia: The shoulder joint is carefully moved while the patient is under general anaesthesia to break up adhesions.
Prognosis
Frozen shoulder resolves completely in most cases, but recovery can take 1 to 3 years. Early and consistent treatment can significantly shorten the duration of symptoms. A small proportion of patients may retain some degree of reduced shoulder mobility long-term.
References
- Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery. 2011;20(2):322-325.
- Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World Journal of Orthopedics. 2015;6(2):263-268.
- National Institute for Health and Care Excellence (NICE). Frozen shoulder: overview and management guidelines. 2022. Available at: https://www.nice.org.uk
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Related search terms: Frozen Shoulder + Frozen-Shoulder + FrozenShoulder