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Frozen Shoulder: Causes, Symptoms & Treatment
Frozen shoulder is a painful condition causing stiffness and limited movement in the shoulder joint. It results from inflammation and scarring of the joint capsule and can last for months to years.
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Frozen shoulder is a painful condition causing stiffness and limited movement in the shoulder joint. It results from inflammation and scarring of the joint capsule and can last for months to years.
What is Frozen Shoulder?
Frozen shoulder, medically known as adhesive capsulitis, is a condition of the shoulder joint characterized by pain and a progressive loss of movement. The joint capsule – the connective tissue surrounding the shoulder joint – becomes inflamed, thickened, and scarred, significantly reducing the range of motion. The condition typically progresses through three distinct phases and may last from several months to a few years.
Causes
The exact cause of frozen shoulder is not always clearly identifiable. There are two main forms:
- Primary (idiopathic) frozen shoulder: Occurs without a clearly identifiable underlying condition. It most commonly affects women between the ages of 40 and 60.
- Secondary frozen shoulder: Develops as a result of another condition or event, such as injury, surgery, stroke, diabetes mellitus, thyroid disorders, or heart disease.
Risk factors include prolonged immobilization of the arm, autoimmune conditions, and hormonal changes.
Symptoms
Frozen shoulder develops gradually and typically progresses through three phases:
- Freezing phase (2–9 months): Increasing shoulder pain, especially at night and during movement. Range of motion begins to decrease.
- Frozen phase (4–12 months): Pain may slightly decrease, but shoulder movement is severely restricted. Daily activities such as dressing or combing hair become difficult.
- Thawing phase (5–24 months): Movement gradually returns and pain diminishes.
Diagnosis
Diagnosis is primarily clinical. The doctor reviews the patient's medical history and performs a physical examination to assess both active and passive range of motion in the shoulder. Additional investigations may include:
- X-ray: To rule out other causes such as osteoarthritis or bone changes.
- Ultrasound: To assess soft tissues and the joint capsule.
- MRI (Magnetic Resonance Imaging): To provide detailed imaging of the joint capsule and surrounding structures.
- Blood tests: To exclude inflammatory or metabolic underlying conditions.
Treatment
Treatment of frozen shoulder depends on the severity and the current phase of the condition. The goals are to relieve pain and restore mobility.
Conservative Treatment
- Physiotherapy: Targeted exercises to mobilize the shoulder joint are the cornerstone of treatment. They should be performed regularly and within a tolerable pain range.
- Pain management: Anti-inflammatory medications (NSAIDs) such as ibuprofen or diclofenac help reduce pain and inflammation.
- Corticosteroid injections: Direct injections into the shoulder joint can significantly reduce inflammation, particularly during the freezing phase.
- Heat and cold therapy: Supportive measures for pain relief and muscle relaxation.
Interventional and Surgical Treatment
- Hydrodilatation: Injection of saline solution and corticosteroids into the joint capsule to stretch and expand it.
- Manipulation under anesthesia: Manual mobilization of the shoulder joint under general anesthesia to mechanically break up adhesions.
- Arthroscopic capsular release: A minimally invasive surgical procedure in which the thickened joint capsule is released to restore mobility.
Prognosis
Frozen shoulder is in most cases self-limiting, meaning it often resolves on its own over time. However, the total duration of the condition can be 1–3 years. With early and consistent treatment, the recovery process can be significantly accelerated. In a small number of patients, some degree of movement restriction may persist long-term.
References
- Zuckerman, J.D. & Rokito, A. - Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery, 20(2), 322–325 (2011).
- Neviaser, A.S. & Hannafin, J.A. - Adhesive capsulitis: a review of current treatment. American Journal of Sports Medicine, 38(11), 2346–2356 (2010).
- National Institute for Health and Care Excellence (NICE) - Shoulder pain: frozen shoulder. Available at: www.nice.org.uk.
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