Frozen Shoulder

Rheumatoid Arthritis

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in the shoulder joint. It occurs when the capsule of connective tissue surrounding the shoulder joint becomes thick, tight, and inflamed, leading to restricted movement and significant discomfort. The condition typically develops gradually over time and can last for several months to a couple of years, often improving slowly on its own. It is most common in people between the ages of 40 and 60 and can affect one or both shoulders.

Stages of Frozen Shoulder​

Frozen shoulder is a condition in which the shoulder capsule thickens, causing stiffness and tightness. Adhesions, or thick bands of tissue, form in the affected area, and there may be a reduction in synovial fluid in the joint. The main symptoms of frozen shoulder are severe pain and difficulty moving the shoulder, either independently or with help. The condition progresses through three stages: freezing, frozen, and thawing. In the freezing stage, pain increases gradually, and range of motion decreases. This stage typically lasts 6 weeks to 9 months. During the frozen stage, which lasts 4 to 6 months, stiffness persists, although pain may improve. Daily activities can be challenging during this time. Finally, during the thawing stage, shoulder motion slowly improves, with complete recovery typically taking 6 months to 2 years.

Symptoms of Frozen Shoulder

The main symptoms of frozen shoulder are severe pain and stiffness in the shoulder joint. The pain is usually constant and may worsen at night, making it difficult to sleep. The stiffness in the shoulder may make it challenging to perform daily activities such as getting dressed, combing hair, or reaching for objects. You may also experience a limited range of motion in your shoulder, making it difficult to move your arm or shoulder freely. In some cases, the pain may improve over time, but the stiffness remains. These symptoms typically develop gradually over time and may worsen over several months before improving. If you are experiencing any of these symptoms, it is essential to see a healthcare professional for an accurate diagnosis and appropriate treatment.

Causes of Frozen Shoulder

The exact causes of frozen shoulder are not fully understood, and there does not appear to be a clear link to arm dominance or occupation. However, certain factors may increase the risk of developing the condition. People with diabetes, for example, are more likely to develop frozen shoulder, and they may experience more significant stiffness that takes longer to improve. Other medical conditions associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease. Frozen shoulder may also develop after a period of immobilization following surgery, fracture, or other injuries. To prevent frozen shoulder, it is recommended to encourage patients to move their shoulder soon after an injury or surgery.

Diagnosis of Frozen Shoulder

To diagnose frozen shoulder, your doctor will first discuss your symptoms and medical history before conducting a physical examination of your shoulder. During the exam, your doctor will move your shoulder in various directions to assess your range of motion and determine if pain occurs. This involves comparing the range of motion when someone else moves your shoulder (passive range of motion) to when you move it yourself (active range of motion). Individuals with frozen shoulder usually have limited range of motion in both active and passive movements.

Your doctor may also order imaging tests such as x-rays, magnetic resonance imaging (MRI), or ultrasound to rule out other causes of pain and stiffness and identify any additional problems in your shoulder, such as arthritis or a torn rotator cuff. While not necessary for the diagnosis of frozen shoulder, these imaging tests may provide additional information to assist in treatment planning.

Complications of Frozen Shoulder

If left untreated, frozen shoulder can result in long-term stiffness and limited range of motion in the affected shoulder. This can make it difficult to perform daily activities and tasks that require reaching or lifting. In addition, frozen shoulder can cause chronic pain and discomfort, which can affect overall quality of life. If the condition is not addressed, it can lead to muscle wasting and weakness in the affected arm, which can further exacerbate mobility issues.

Treatment of Frozen Shoulder

Frozen shoulder usually improves over time, but it may take up to three years. The primary focus of treatment is to manage pain and restore movement and strength through physical therapy.

For most people, simple treatments like nonsteroidal anti-inflammatory drugs, steroid injections, and physical therapy can help control pain and restore motion. If these treatments are not successful, hydrodilatation may be recommended. This procedure involves injecting fluid into the shoulder joint to expand and stretch the joint capsule. If nonsurgical methods fail, surgery may be considered during Stage 2 of frozen shoulder. The goal of surgery is to stretch and release the stiffened joint capsule, and the most common procedures are manipulation under anesthesia and shoulder arthroscopy.

Following surgery, physical therapy is necessary to maintain the motion achieved during surgery. Long-term outcomes after surgery are generally good, with most patients experiencing reduced or no pain and improved range of motion. However, in some cases, stiffness may persist even after several years, particularly in diabetic patients. While rare, frozen shoulder can recur if contributing factors like diabetes remain present.