What is a Frozen Shoulder?
Frozen shoulder, also known as adhesive capsulitis, is characterized by stiffness and pain in the shoulder joint, significantly limiting movement. It can be debilitating, affecting daily activities like dressing, combing hair, or reaching overhead. While the exact cause of frozen shoulder remains elusive in some cases, understanding the different types, symptoms, diagnosis, and treatment options can help manage this condition effectively.
Understanding the Shoulder Joint
The shoulder joint is a ball-and-socket joint, where the ball (humeral head) of the upper arm bone fits into the socket (glenoid) of the shoulder blade. A capsule of connective tissue surrounds the joint, providing stability and allowing for a wide range of motion.
What Causes Frozen Shoulder?
There are two main categories of frozen shoulder:
- Primary Frozen Shoulder (Idiopathic Adhesive Capsulitis): This occurs without a readily identifiable cause. It is more common in people with diabetes, thyroid problems, and those aged 50-60, particularly women.
- Secondary Frozen Shoulder: This develops due to another condition or event that restricts shoulder movement for an extended period. Examples include shoulder surgery, fracture healing, stroke, or even heart surgery.
Symptoms of Frozen Shoulder
The symptoms of a frozen shoulder typically progress through three stages:
- Freezing Stage (2-9 Months): This stage is characterized by increasing pain, often worse at night and with rest. The shoulder joint becomes progressively stiffer, and muscle spasms can occur.
- Frozen Stage (4-12 Months): Pain intensity gradually decreases in this stage. However, the stiffness becomes more prominent, significantly restricting both active (self-initiated) and passive (assisted) movement of the shoulder.
- Thawing Stage (5-24 Months): The pain subsides further in this stage, and the range of motion slowly improves. This stage can be quite unpredictable, with some individuals regaining full mobility within 6 months, while others may experience residual stiffness even after 3 years.
How is Frozen Shoulder Diagnosed?
Diagnosis of a frozen shoulder is primarily based on a thorough physical examination by a doctor who will assess your range of motion and pain levels. Imaging tests like X-rays are usually not required for diagnosis but may be helpful to rule out other conditions mimicking frozen shoulder symptoms.
- Ultrasonography: This is a quick and easy way to visualize the shoulder joint and identify the thickening of the ligaments or adhesions. However, the accuracy depends on the operator’s skill.
- MRI: While more expensive than ultrasound, MRI offers a more detailed picture of the joint and surrounding tissues. It can help identify loss of the axillary recess, a hallmark of adhesive capsulitis.
How is Frozen Shoulder Treated?
The primary goals of frozen shoulder treatment are pain management and improvement of shoulder mobility. The specific treatment approach depends on the type and stage of the frozen shoulder.
Treatment for Secondary Frozen Shoulder
Secondary frozen shoulder is generally easier to manage than primary frozen shoulder. The mainstay of treatment involves:
- Physical Therapy: A physical therapist will guide you through exercises designed to improve your range of motion and flexibility. These exercises can be performed independently at home or under the supervision of a therapist. Initially, the focus might be on gentle range-of-motion exercises followed by gradual progression to more challenging exercises without causing strain.
- Moist Heat Therapy: Applying moist heat packs to the shoulder can help relax muscles and improve blood flow, promoting pain relief.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers like ibuprofen or naproxen can help manage pain and inflammation.
Treatment for Primary Frozen Shoulder
The treatment approach for primary frozen shoulder varies depending on the stage of the condition:
- Freezing Stage:
- Pain Management and Physical Therapy: This is the first line of treatment. Pain relievers like NSAIDs can help manage pain, while physical therapy exercises can help maintain some degree of movement and prevent further stiffness.
- Intra-articular Steroid Injections: Injections of corticosteroids directly into the shoulder joint can be beneficial for managing severe pain.
- Frozen Stage:
- Physical Therapy: Here, the focus of physical therapy shifts towards joint mobilization techniques to break down adhesions and improve range of motion.
- Intra-articular Steroid Injections: Generally not recommended in this stage as they offer minimal benefit.
- Hydro-distension: This procedure involves injecting a large volume of saline solution into the joint to stretch the capsule and break down adhesions. While promising in theory, it has not yielded consistent results in clinical practice.
- Manipulation Under Anesthesia (MUA): This controversial procedure involves manipulating the shoulder joint under anesthesia to force movement and break down adhesions. However, it carries a risk of complications like tendon tears, ligament ruptures, and even fractures.
- Arthroscopic Capsular Release: This minimally invasive surgical procedure is considered the treatment of choice for patients who fail to improve with physiotherapy after 3 months. A surgeon uses a small camera and specialized instruments inserted through tiny incisions to cut or release the tightened capsule, restoring shoulder movement. Studies have shown this procedure to be highly effective with good patient satisfaction.
Secondary Prevention of Frozen Shoulder
Following shoulder surgery, consistent physical therapy is crucial to maintain joint mobility and prevent stiffness. Recovery time varies depending on the individual and the type of surgery, typically ranging from 6 weeks to 3 months.
Here are some additional points for preventing a recurrence of a frozen shoulder:
- Address Underlying Conditions: If you have diabetes or other risk factors, managing those conditions can help reduce the risk of developing a frozen shoulder again.
Avoid Prolonged Immobilization: After an injury or surgery, it’s important to follow your doctor’s recommendations for gentle movement exercises to prevent stiffness from developing.
