Frozen Shoulder

Frozen Shoulder Overview

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by stiffness, pain, and limited range of motion in the shoulder joint. It occurs when the capsule surrounding the shoulder joint thickens and tightens, restricting movement. This condition typically develops gradually and can take months to years to resolve.

Symptoms

Frozen shoulder progresses through three stages:

1. Freezing stage (painful stage)

• Gradual onset of pain in the shoulder, often worse at night.

• Increasing stiffness, making shoulder movements difficult.

• Duration: 6–9 months.

2. Frozen stage (stiff stage)

• Pain may diminish, but stiffness becomes severe.

• Difficulty performing daily activities, such as dressing or reaching overhead.

• Duration: 4–12 months.

3. Thawing stage (recovery stage)

• Gradual improvement in shoulder mobility and range of motion.

• Pain continues to decrease.

• Duration: 6 months to 2 years.

Causes and risk factors

The exact cause is often unclear, but potential factors include:

1. Prolonged immobilisation: After surgery, injury, or fracture.

2. Underlying conditions:

   • Diabetes: A major risk factor, affecting 10–20% of diabetic individuals.

   • Thyroid disorders: Hypothyroidism or hyperthyroidism.

   • Cardiovascular disease.

   • Parkinson’s disease.

3. Inflammatory processes: Chronic inflammation within the shoulder joint capsule.

4. Age and gender:

   • Common in individuals aged 40–60.

   • More prevalent in women.

Diagnosis

1. Medical history and symptoms:

   • Assess the onset, nature, and progression of symptoms.

2. Physical examination:

   • Limited active and passive range of motion.

   • Pain during specific movements (e.g. external rotation).

3. Imaging:

   • X-rays: Rule out other conditions like arthritis.

   • MRI or ultrasound: May reveal inflammation or thickening of the joint capsule.

Treatment options

1. Non-surgical management

Most cases resolve with conservative treatments.

• Physical therapy:

  • Gentle stretching and strengthening exercises to restore mobility.

  • Techniques may include passive movements, active-assisted exercises, and isometric strengthening.

• Medications:

  • Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen).

  • Prescription pain relief for severe cases.

• Corticosteroid Injections:

  • Reduces inflammation and pain, especially in the freezing stage.

• Hydrodilatation (Distension srthrography):

  • Injection of saline and steroids into the shoulder joint to stretch the capsule.

2. Surgical management

Reserved for severe, persistent cases.

• Manipulation under anaesthesia (MUA):

  • The shoulder is gently moved while under anaesthesia to break adhesions.

• Arthroscopic surgery:

  • Minimally invasive procedure to release tight areas of the joint capsule.

Recovery process

• Timeline: Frozen shoulder often resolves fully, but it may take up to 2–3 years.

• Progressive rehabilitation:

  • Early stages focus on pain management and gentle stretching.

  • Later stages involve strengthening and restoring full range of motion.

Exercises for frozen shoulder

Gentle stretching (Freezing/Frozen Stage)

1. Pendulum exercises:

   • Lean forward and let your affected arm hang down.

   • Gently swing your arm in small circles.

2. Towel stretch:

   • Hold a towel behind your back with one hand, and grasp it with the other.

   • Gently pull the towel upward with the good arm to stretch the affected shoulder.

3. Cross-body Stretch:

   • Use your good arm to pull the affected arm across your body at shoulder height.

Strengthening (Thawing stage)

1. Wall walk:

   • Stand facing a wall and use your fingers to "walk" your hand upward.

2. External rotation with resistance Band:

   • Secure a resistance band and hold it with the affected hand.

   • Rotate your arm outward while keeping your elbow close to your body.

3. Overhead stretch:

   • Lie on your back and use a stick or broom to push the affected arm overhead.

Complications

1. Persistent stiffness and reduced range of motion.

2. Chronic pain in severe or untreated cases.

3. Secondary issues due to altered movement patterns (e.g. neck or upper back pain).

Prevention

1. Stay active: Avoid prolonged shoulder immobilisation.

2. Stretch regularly: Incorporate gentle shoulder exercises into your routine.

3. Address underlying conditions: Manage diabetes, thyroid disorders, or other risk factors.

4. Post-injury care: Begin rehabilitation promptly after any shoulder surgery or injury.