Let’s take a look at what exactly is a frozen shoulder, its causes, symptoms, diagnosis, and treatment, including prevention.

What is a Frozen Shoulder?

Frozen shoulder, also called adhesive capsulitis, is a painful condition in which your shoulder joint becomes stiff. This results in limited movement. 

As the pain in your shoulder joint increases, the use of your shoulder joint reduces, which makes your shoulder capsule (the strong connective tissue surrounding the shoulder joint) thicker and stiffer, hence the name “frozen”.

Frozen shoulders are more likely to occur in women. It typically affects people after the age of 40. 

What are the Causes of a Frozen Shoulder?

A frozen shoulder occurs when the shoulder joint capsule becomes thick, stiff, and inflamed, restricting its movement. 

It could occur due to aging. Some other causes that could contribute to a frozen shoulder include:

  • Recent shoulder injuries such as a rotator cuff tear or shoulder fracture.

  • Recovery from a major surgery that restricts your shoulder or arm movements such as mastectomy (surgical removal of one or both breasts).

What are the Risk Factors for a Frozen Shoulder?

Some of the risk factors for a frozen shoulder include:

  • Chronic metabolic disorders such as diabetes, hyperthyroidism (overactive thyroid gland), and hypothyroidism (underactive thyroid gland)

  • Parkinson’s disease

  • Cardiovascular (heart) disease

  • Stroke

What are the Signs and Symptoms of a Frozen Shoulder?

The signs and symptoms of a frozen shoulder begin gradually, worsen over time, and then resolve within 1 to 3 years.  

The symptoms can be distinguished into three stages. Each stage can last for a few months.

  • Stage 1 or the "freezing" (painful) stage: The shoulder becomes stiff and is painful to move. The pain continues to increase and may worsen at night. This stage lasts for about 6 weeks to 9 months.

  • Stage 2 or the "frozen" (stiffening) stage: Shoulder pain may lessen, but the shoulder remains stiff. It is difficult to perform daily activities. This phase may occur at around 4 months and last up to 12 months. 

  • Stage 3 or the "thawing" (recovery) stage: Shoulder pain lessens and the ability to move the shoulder slowly improves. You may recover and regain your normal strength and motion. It may last for about 6 months to 2 years.

How is a Frozen Shoulder Diagnosed?

Your doctor will perform a thorough physical inspection of your shoulder. They will ask questions to understand your lifestyle and the cause of your frozen shoulder. 

Your range of motion will be checked by rotating your shoulder in different directions.

For a better evaluation, an X-ray may be ordered. In some cases, advanced imaging tests, such as Magnetic Resonance Imaging (MRI) or ultrasound may be ordered.

What are the Treatment Options for a Frozen Shoulder?

Treatment for a frozen shoulder involves physiotherapy aimed at increasing the range of motion. This includes stretching and different motion exercises to improve shoulder joint movement. 

Other options include:

  • Medications for pain relief.

  • Hot and cold compresses to help reduce pain and swelling.

  • Shoulder injections and/or numbing medications.

  • Hydrodilation (joint distension), wherein sterile water is injected into the joint capsule to help stretch the shoulder tissues and make it easier to move.

  • Transcutaneous electrical nerve stimulation (TENS), in which a small battery-operated device is used to deliver tiny electrical currents at specific points to reduce pain by blocking nerve impulses.

If conservative treatment fails to provide relief, your doctor may recommend surgery. The different surgical procedures may include:

  • Shoulder arthroscopy: Performed to loosen the shoulder joint capsule so that it can move more freely. 

  • Shoulder manipulation with surgical release of the capsule: Aimed at loosening up the tightened, inflamed shoulder tissue. 

How can you Prevent a Frozen Shoulder?

The chances of having a frozen shoulder are reduced if physical therapy is started shortly after any shoulder injury that restricts shoulder movements. 

Your orthopedic doctor or physical therapist can develop an exercise program to meet your specific needs.

Simple treatments, such as the use of pain relievers and shoulder exercises, in combination with a cortisone injection, are often enough to restore shoulder motion and function within a year or even less. 

If a frozen shoulder is left untreated, your range of motion may get better on its own, but that would take a long time. Complete recovery may take up to two years. Visit your orthopedic doctor to learn more about a frozen shoulder.


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