Shoulder Joint Conditions

Frozen Shoulder

Do you have pain or stiffness in your shoulder – or both?

Then you may be suffering from frozen shoulder and you should see an orthopaedic shoulder surgeon who specialises in shoulder issues as soon as possible.

Not only is frozen shoulder syndrome painful and problematic, it may be indicative of greater health issues.

What is a Frozen Shoulder?

Frozen shoulder syndrome or adhesive capsulitis is extreme stiffness in the shoulder joint, making it difficult and even painful to move or rotate the shoulder.

It typically occurs in individuals between the ages of forty and sixty, and if you have diabetes you are more likely to have to deal with frozen shoulder syndrome.

It is more common in women.

Frozen shoulder syndrome may have a slow recovery, after the initial period of worsening symptoms, frozen shoulder joints tend to improve with treatment.

That said, full recovery from frozen shoulder syndrome may take up to 5 years.

The primary treatment recommendation for frozen syndrome is physiotherapy with a focus on improving shoulder flexibility, but more serious cases may require more complex solutions such as surgery.

When you have a frozen shoulder, the capsule of cartilage that surrounds your shoulder joint becomes stiff and tight, making it difficult for you to move or rotate your arm normally.

The tissue tightens and forms stiff adhesions and the synovial fluid – the fluid that lubricates the shoulder joint – is reduced.

If you have a frozen shoulder, you’ll likely be unable to move your shoulder either on your own or with the help of a therapist.

Frozen shoulder stages and frozen shoulder syndrome

Frozen shoulder syndrome has three stages: freezing, frozen, and thawing.

During the initial “freezing” stage of frozen shoulder syndrome, the pain in your shoulder will ramp up and you’ll start to lose your range of motion and the ability to rotate your shoulder; this stage tends to last from 6 to 9 months.

This is normally considered the most painful stage of having a frozen shoulder.

The 2nd stage or the “frozen” stage may be less painful, but your shoulder will still be stiff and make daily activities uncomfortable at best, if not difficult or even impossible.

It usually lasts between 6 to 12 months.

Frozen shoulder syndrome usually ends with a thawing stage after treatment; this involves a slow improvement, decrease in pain, and a return to normal range of motion and strength.

It usually takes between 6 months and 2 years, and it can be hastened with physiotherapy and other treatment under the supervision of an experienced orthopaedic doctor.

What happens in your shoulder joints when you have frozen shoulder syndrome?

You should know that your shoulder joints are made up of three bones – the humerus or upper arm bone, the scapula or shoulder blade, and the clavicle or collarbone.

The shoulder capsule is the cartilage that surrounds the ball and socket of the shoulder joint, which is lubricated by synovial fluid in order to help you move and rotate your arms.

When you have a frozen shoulder, the cartilage in the shoulder capsule thickens and grows stiff, making it difficult to move your shoulder.

What causes a frozen shoulder?

Frozen shoulder syndrome can be caused by many different things, and the causes can be somewhat random or not fully understood by the medical community (yet).

There’s also no obvious connection to left or right arm dominance in regard to whether you’ll experience frozen shoulder issues; what’s more, there’s no connection between occupation, or physical activity and frozen shoulder syndrome.

However, there are a few factors that can contribute to frozen shoulder, such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s diseases, and various cardiac diseases or disorders.

Be particularly aware that if you have diabetes, you may be more susceptible to frozen shoulder syndrome and suffer from more stiffness and pain before your shoulder thaws.

In addition, if you’ve been immobilized by surgery, a stroke, broken bones, or other injuries for a period of time, you may be more likely to suffer from frozen shoulder syndrome.

It’s important to be sure to move your shoulders as soon as possible after surgery, or other injuries in order to prevent frozen shoulder.

What are frozen shoulder symptoms?

If you are experiencing pain and stiffness in your shoulder joint to the point where you have trouble lifting, rotating, or moving your arm normally and you haven’t recently experienced an acute injury, you may be suffering from frozen shoulder syndrome.

The type of pain experienced during frozen shoulder syndrome tends to be dull or aching pain in your upper arm and outer shoulder area.
It is normally heightened during the onset of frozen shoulder syndrome and more noticeable when you move or rotate your arm.

Some similar issues to frozen shoulder syndrome include shoulder impingement and shoulder instability.

The symptoms of frozen shoulder syndrome may be signs of other health problems, so if you think you have a frozen shoulder you should see a doctor as soon as possible.

When should you see a physician for a frozen shoulder?

If you are experiencing pain and stiffness in your shoulder joint or upper arm and back area when you move your arm, then you may be dealing with frozen shoulder syndrome.

This goes doubly so if you happen to suffer from any of the aforementioned health conditions, like diabetes or Parkinson’s disease.

It’s also important to have your shoulder checked out if you experience stiffness and pain when moving or rotating your arm after a major medical procedure like a mastectomy, or if you’ve experienced a stroke, since the relatively immobility required during rehabilitation may cause frozen shoulder syndrome.

How is frozen shoulder syndrome diagnosed?

When you see a doctor for frozen shoulder syndrome or related problems, note that your doctor will do a frozen shoulder test by examining your shoulder and your range of motion to uncover exactly when and where the pain or stiffness occurs.

Individuals with frozen shoulders will have a limited range of motion when moving their shoulder actively (or on their own) and passively (when a shoulder surgeon or physiotherapist moves it for them).

If your doctor suspects that you have frozen shoulder or related problems, they might order imaging tests such as X-rays, MRIs, or ultrasounds.
These may show other problems like arthritis or torn rotator cuffs; imaging tests aren’t required to diagnose a frozen shoulder, but they may help to identify or narrow out other problems.

How do you treat a frozen shoulder?

Physiotherapy that involves specific frozen shoulder exercises meant to restore motion and decrease pain is generally the first step towards treating frozen shoulder syndrome.

Frozen shoulder exercises can be done under the supervision of a trained physiotherapist or even a home program depending on the severity of the problem and your own capabilities.

Heat packs may be recommended to help loosen the muscles before stretching as well.

Most individuals suffering from mild frozen shoulder can solve the problem with relatively simple and non-invasive treatments aimed at controlling the pain and restoring range of motion.

Aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs may be recommended to reduce pain, swelling, and stiffness as well.

For more problematic and painful cases of frozen shoulder, steroid or cortisone injections may be recommended.

In these cases, the anti-inflammatory drugs are injected directly into the shoulder joint.

Your doctor may also suggest hydrodilation if your frozen shoulder isn’t relieved by other methods once you are out of the painful freezing stage.
This involves injecting a large amount of sterile fluid directly into the shoulder capsule in order to expand and stretch things out; it’s conducted by a radiologist who uses imaging while injecting to guide the location of the fluid.

If the above methods fail to treat your frozen shoulder, surgical treatment may be recommended. This arthroscopic surgery is done under anesthesia and it typically occurs during the second or “frozen” stage of frozen shoulder syndrome with the aim of manipulating and stretching the stiffened capsule, therefore releasing it by forcing it to move.

This makes the scar tissue stretch or tear, increasing the range of motion and releasing the tightness or “frozeness”.

In more extreme cases, the orthopaedic surgeon will cut through the tight areas of the shoulder capsule using miniature arthroscopic instruments inserted through tiny incisions made in the shoulder and upper arm area.
Often, surgical manipulation and these types of cuts are combined during shoulder arthroscopy to achieve optimal results.

This type of surgery is highly successful and provides immediate restoration of range of movement. Physiotherapy is required after the procedure to maintain range of movement and then rehabilitate the muscles and tendons of the shoulder to restore your function.

Recovery from a frozen shoulder

Physiotherapy, heat treatments, rest, and anti-inflammatory medication will almost always be prescribed for a frozen shoulder.

If you’ve had surgery for a frozen shoulder, you will likely be prescribed physiotherapy for 3 to 6 months (or longer). Recovering from a frozen shoulder is a slow process but therapy and rest are important in order to return to your every day activities in comfort.

Be aware that if you are diabetic or are recovering from a significant medical procedure, you may still have some degree of stiffness even after surgery and physiotherapy.

How to prevent frozen shoulder

Ensuring that your shoulders are regularly rotated passively or actively after surgery, or any other injury or health problem that results in immobilization is one key way to prevent frozen shoulder issues.

If you are diabetic or have other health problems that make you susceptible to frozen shoulder, then you should see a doctor upon experiencing any unusual pain or stiffness in your shoulder, back, or upper arm area.
An ounce of prevention is worth a pound of cure!

Devinder Garewal

Mr. Devinder Garewal

MBBS, BMedSci, FRACS (Orth), FAOrthA

Devinder completed his medical qualifications from the University of Melbourne and is a Fellow of the Royal Australiasian College of Surgeons and the Australian Orthopaedic Association.

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