Frozen shoulder is an inflammation in the shoulder region that leads to pain and loss in motion. This condition is also termed as adhesive capsulitis and is characterized by a gradual increase in symptoms, which become worse over time, subsiding in two to three years in most instances.
There is an increased risk for developing frozen shoulder after surgery that restricts movement of the shoulder like mastectomy
or even stroke. The condition is characterised by a stiffness of the joints due to the formation of scar tissue, which makes movement of the shoulder extremely painful
Frozen shoulder occurs only in the shoulder region and this type of pain or inflammation is not associated with any other joint in the body. The pain experienced during a frozen shoulder is constant, and is more pronounced during the night and colder climate.
Which Age Group is Commonly Affected with Frozen Shoulder?
Frozen shoulder usually occurs in people in their 40s or 60s, with greater prevalence among women.
What are the Causes of Frozen Shoulder?
Frozen shoulder is an inflammation of the shoulder joint and there is no single cause that leads to this condition. Instead, there are multiple risk factors that could lead to a frozen shoulder,
- An injury in the shoulder region
- A surgery or procedure performed which restricts the movement of the shoulder
- Open heart surgery
- Parkinson’s disease
- Closed head trauma
- Overuse of the shoulder
Frozen shoulder usually never affects the same shoulder again but the other shoulder could be affected with a frozen shoulder if the condition determines it.
What are the Symptoms of a Frozen Shoulder?
The symptoms of a frozen shoulder develop very gradually and they normally go through the following 3 phases:
- Inflammatory Phase: This phase is also called the freezing phase where the patient senses pain, when the arm is not in use, and then slowly even when in use. Most patients, at this stage, usually associate this pain with a minor injury or trauma to the region, which might have occurred in the recent past. Though, in most cases, the two are unconnected. This phase may last anywhere between 3 to 9 months and the patient witnesses a steady increase in pain and a growing ‘freezing’ or stiffness of the shoulder.
- Frozen Phase: During this phase, there is a slow let up in the pain when the shoulder is at rest. However, the stiffness and pain when in movement remain. The entire phase lasts anywhere between 4 to 12 months.
- Thawing Phase: Once in this phase, the patient notices a gradual reduction in pain and returns to mobility of the shoulder. It may take anywhere between 3 months to 2 to 3 years for normalcy to set in.
How to Diagnose a Frozen Shoulder?
Diagnosis is largely made by physical examination and by assessing the history of the condition. The patient will find it painful to undergo the strength test and there are chances of a misdiagnosis with
- Impingement syndrome
- Rotator cuff syndrome
An x-ray would differentiate a frozen shoulder from
- Chronic rotator cuff tear
- Calcific tendonitis
Very rarely, an MRI scan
is used to diagnose a frozen shoulder, depicted by a thickening of the joint capsule.
How do you Treat a Frozen Shoulder?
Most often, a frozen shoulder resolves by itself in a matter of 3 years, independent of the type of treatment administered. However, the treatment options depend on the stage of the condition.
Non-surgical methods of treatment:
- Physiotherapist monitored stretching exercises
- Anti-inflammatory medication
- Oral cortisone
- Corticosteroid injections – In a study published in September 2015 by Prestgaard T and colleagues, it was found that corticosteroid injections produced significant relief when compared to sham injections.
- A diet low in complex carbohydrate and gluten
- Use of ice to reduce swelling and pain
- Intake of antioxidants
Surgical methods of treatment:
Surgical methods involve the use of shoulder arthroscopy under anaesthesia. This medical procedure is performed to remove scar tissue and to cut tight ligaments, aiding in better movement of the shoulder. After the surgery, painkillers
are provided which will help continue physical therapy.
It is extremely important to continue physiotherapy and to keep the shoulder moving after the surgery, as it could lead to a return of frozen shoulder if it’s left immobilized for long.
Complications of surgery
- When the shoulder is moved with increased force during surgery, it could lead to arm breaking
- The pain and stiffness may not recede even after surgery
Latest news reports suggest that the use of wearable technology could dramatically help patients suffering from frozen shoulder. Many doctors now prescribe wearable technology for diabetes patients to check their insulin levels
at regular intervals and to prevent unprecedented spikes.
Wearable technology for a frozen shoulder involves the use of a device that can be worn under clothes and which will provide ultrasound therapy for a few hours every day. This has been found to provide immense relief from pain and improve mobility among patients.
This method of treatment is revolutionising medicine and it is estimated that by the year 2025, wearable technology would come into common use.
Low-level laser therapy (LLL):
In a study conducted and published in May 2015 by Ip D and Fu NY on 35 patients with frozen shoulder aged over 65 years, it was found that low-level laser therapy resulted in over 90% improvement in clinical outcome. This study could herald in pain-free procedures that provide relief to the elderly and the young alike.
What is the Prognosis for a Patient with Frozen Shoulder?
Frozen shoulder recedes gradually after a year with surgery and care while it could get back to normal within 2 years without any specific treatment.
Prevention of Frozen Shoulder
The pain and immobility are demanding factors of frozen shoulder and careful preventive steps will aid in minimizing the risk for this condition.
- Once the initial pain develops and before the stiffness fully sets in, consult a doctor for treatment options that could prevent immobility of the shoulder.
- Control systemic diseases like diabetes, which increase the risk for a frozen shoulder.
- Exercise the shoulder after surgical procedures that could immobilize shoulders and lead to a frozen shoulder.
- Practice a good pose while performing daily chores like using the computer. A bad hunch can affect the shoulder dynamics leading to stress that could increase the risk for a frozen shoulder.
- Reduce the intake of processed foods and include only minimally processed foods in your diet.
- Consult a doctor immediately if there has been an injury to the shoulder, especially during sports. Rest is one of the best options but carefully monitored exercises are also important to maintain mobility.
- Vitamin D should be taken as a supplement.
What are the Exercises for a Frozen Shoulder?
- Get the arm over your head while lying down:
Lie down flat on your back and using your ‘good arm’ hold the wrist of your arm affected with the frozen shoulder and gently ease it up over your head. Hold the position for a count of 10 and then gently bring it back down.
- Get the arm over your head while sitting down:
Sit down in a chair and rest your affected arm on a table next to you. The table should be tall enough to reach your shoulder while you sit down. Place your affected arm outstretched in front of you and slowly bend your head down, as you do this, stretch your arm over your head.
- Stretch your arm overhead with an elastic rope:
Tie an elastic, stretchable rope to a hook on the ceiling. Sit down in a chair below it. The rope should reach just above your head. Pull it down with your ‘good’ arm and then hold it with your affected arm. Gently raise the arm up with the tension created in the elastic rope. Repeat this exercise 10 times.
- Hold a stationary object with your affected arm and move your body:
Hold a stationary pole or a door knob with your affected arm and then gently swing your body away and then move back in. Repeat this exercise 10 times.
- Avoid overstretching or excessive physical activity that could make your condition worse
- Chinese plasters and certain liniments are believed to bring about pain relief.
- Acupressure is another alternative treatment method that is used to relieve pain.