1) What are the causes of shoulder pain?

Common causes of shoulder pain are frozen shoulder (Peri-arthritis Shoulder), subacromial bursitis (Impingement), cuff tear, labral tear and shoulder arthritis. Other causes include AC joint arthritis, Biceps tendon problem, calcific tendinitis, previous fracture, nerve problems, SC joint problem and scapula problems.

Sometimes, shoulder pain can be caused by certain neck problems. It is better to get checked by the doctor to find out whether the pain in the shoulder is caused by some problem in the shoulder itself or as a consequence of neck problem (partly or as a whole).

2) What is frozen shoulder?

Frozen shoulder is an extremely painful condition. The shoulder joint can be stiff as well (completely or partially restricted movements).

3) What are the other names of frozen shoulder?

Adhesive capsulitis and Periarthritis shoulder. 

4) What are the causes of frozen shoulder?

The exact cause of the frozen shoulder is not fully understood. It is thought to happen when scar tissue forms on the shoulder. This eventually causes the capsule of the shoulder joint to thicken and tighten, therefore, leaving less room for movements. Movements may become stiff and painful. Frozen shoulder is common in people with diabetes. 

5) What are the risk factors for frozen shoulder?

Age > 40 years, common in female than male (70%:30%), recent trauma, diabetes (10 to 20%).  

The uncommon risk factors are a stroke, hyperthyroidism, hypothyroidism, heart problems and Parkinson’s disease. 

6) What are the symptoms of frozen shoulder?

A patient with frozen shoulder will have pain and stiffness. Symptoms usually develop gradually, then gets worse gradually and then resolve within a two-year period.

  • Freezing, or painful stage: The shoulder becomes stiff and then very painful with movement. Movement becomes limited. Pain typically worsens at night.
  • Frozen, or adhesive stage: The shoulder becomes increasingly stiff, severely limiting the range of motion. Pain may not diminish, but it does not usually worsen.
  • Thawing stage: Movement of the shoulder begins to improve. Pain may fade but occasionally recur.

7) Is frozen shoulder self-limiting?

Yes, it is self-limiting. It usually resolves within 2 years but the pain and stiffness caused by it can be debilitating.

8) How to diagnose frozen shoulder?

Doctors will ask for more detailed history and do the examination of the shoulder. Usually, there will be a restriction of movements and pain. He will do an X-ray.

9) Why is an X-ray essential for frozen shoulder?

It is essential to rule out other conditions which share features similar to that of frozen shoulder like arthritis and tumour.

10) What are the treatment options available? 

The first step is to treat it with painkillers and physiotherapy. If pain does not settle with these then we can do hydrodilatation either in the clinic or under X-ray guidance.  About 90% of patients find improvement with this. Ozone (O3) injection also helps.If not settled with the above-mentioned measures (usually rare) then you might need Manipulation under anaesthesia or arthroscopic capsular release.