What does it mean to have a frozen shoulder?

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What does it mean to have a frozen shoulder?

What is a frozen shoulder and what does it mean to the patient?

A frozen shoulder (adhesive capsulitis) is a condition in which the movement of the shoulder becomes limited like it is “frozen” in position and often causes pain. This occurs when the strong connective tissue (shoulder joint capsule) surrounding the shoulder joint becomes stiff, thick, and inflamed.

This means that patients may have difficulty carrying out their usual daily activities due to the immobility of their shoulders. However, there are treatments that they could go for to regain activity in their frozen shoulder.

What are the predisposing factors?

There are a few predisposing factors that play a role in one’s chances of developing a frozen shoulder. The factors are:

  • Aged between 40-60 years old
  • Females have a higher risk than males
  • Prolonged immobility in the shoulder
    • Recent shoulder injuries, broken arm, recovery from surgery, stroke
  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Parkinson’s disease

What are the symptoms of a frozen shoulder during the different phases?

There are three phases of a frozen shoulder and in each phase, different symptoms are exhibited.

Phase Symptoms
The “freezing” phaseThe shoulder becomes stiff and is painful to moveThe pain and the inability to move the shoulder increases gradually and may worsen at nightThis stage lasts around 6 weeks to 9 months
The “frozen” phaseAlthough the pain may be less severe, the shoulder still remains stiff or may even become stiffer. Hence, completing daily activities remains toughThis stage lasts around 2 to 6 months
The “thawing” phaseThe pain lessens and the range of motion in the shoulder improves graduallyFull or near full recovery occurs as normal strength and motion return slowlyThis stage lasts around 6 months to 2 years

How is a frozen shoulder diagnosed?

A frozen shoulder is diagnosed through a physical examination and imaging tests. The doctor will discuss your symptoms with you before proceeding to a physical examination.

Physical examination

The doctor will move your shoulder in various directions to evaluate your shoulder’s range of motion and to check if there is any pain with movement. Your doctor may inject anesthetic in your shoulder to numb the pain so that they can better judge your active and passive ranges of motion.

Imaging tests

Examinations such as ultrasound and MRI tests can be used to confirm the diagnosis and assess the soft tissues within the joint for concomitant injuries.

What are the treatment options?

Treatment options include both non-surgical and surgical methods.

Non-surgical options

Non-surgical treatment options aim to relieve pain until the “freezing” phase passes. These treatments include:

  • Anti-inflammatory medication for acute pain control
  • High volume image-guided injections to break the adhesive capsulitis.
  • Physical therapy to help restore as much mobility in your shoulder as possible.
  • In some cases, manipulation under anaesthesia is used to restore the range of motion to the shoulder.

Surgical options

Most frozen shoulders get better within 1-1.5 years. However, if the treatments above have not been effective in relieving pain or shoulder stiffness, shoulder arthroscopy may be recommended.

This is a minimally invasive surgery. Small incisions are made in your shoulder and a camera is inserted into the incision. This will allow the surgeon to view your shoulder joint through a monitor. The surgeon will then cut through the tight parts of your joint capsule, and remove scar tissue and adhesions from inside your shoulder joint.

Rehabilitation and recovery

After a shoulder arthroscopy, physical therapy is required for patients to have their full range of motion back within 3 months.

Through physical therapy, your physical therapist would teach you certain exercises for you to perform. Over time, these exercises will progressively get tougher as you start to gain back your range of motion. This process can take up to several weeks.

The recovery process may seem long and tedious but it is extremely important to give yourself time to fully recover. Only then, will you be able to regain your full range of motion and be able to perform most of your daily activities.

For an assessment of your condition, please book an appointment with Dr. Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology