Frozen Shoulder: Symptoms, Causes, Types, Diagnosis, and Treatments
Frozen shoulder, medically known as adhesive capsulitis, is a common yet often misunderstood condition characterized by stiffness, pain, and restricted motion in the shoulder joint. It can significantly impact daily activities and quality of life if not diagnosed and treated appropriately.
In this comprehensive article, we will explore everything you need to know about frozen-shoulder — its symptoms, underlying causes, different types, diagnostic methods, and effective treatments. Whether you are a patient, caregiver, or simply curious, this guide will provide a thorough understanding of this condition.
What is Frozen Shoulder?
Frozen shoulder is a condition where the shoulder capsule—the connective tissue surrounding the shoulder joint—becomes inflamed, thickened, and tight. This leads to pain and severely limited shoulder mobility. The name “frozen” comes from the joint’s progressive loss of motion, making the shoulder feel stiff and “frozen” in place.
The shoulder is a ball-and-socket joint with a wide range of motion. When the capsule tightens and forms adhesions, it restricts movement, causing difficulty in lifting the arm, reaching behind the back, or performing everyday tasks.
Symptoms of Frozen Shoulder
Frozen shoulder usually develops gradually, progressing through three distinct stages, each with specific symptoms:
1. Freezing Stage
- Duration: 6 weeks to 9 months
- Symptoms:
- Gradual onset of dull or aching shoulder pain
- Increasing pain with shoulder movement
- Stiffness starts to develop, making movements difficult
- Night pain that can disturb sleep
2. Frozen Stage
- Duration: 4 to 6 months
- Symptoms:
- Shoulder stiffness becomes more pronounced
- Pain may lessen, but the shoulder becomes more restricted
- Difficulty performing routine movements such as dressing, combing hair, or reaching overhead
3. Thawing Stage
- Duration: 6 months to 2 years
- Symptoms:
- Gradual improvement in shoulder motion
- Pain continues to decrease
- Strength may improve as mobility returns
Other Common Symptoms
- Limited range of motion in both active (when you move the shoulder yourself) and passive (when someone else moves your shoulder) movements
- Difficulty with internal rotation (reaching behind your back) and external rotation (reaching outwards)
- A feeling of tightness or “catching” in the shoulder joint
Causes of Frozen Shoulder
Frozen shoulder can develop without any apparent injury or trauma. However, several risk factors and underlying conditions are commonly associated with the condition.
1. Primary (Idiopathic) Frozen-Shoulder
- The exact cause is unknown
- It develops spontaneously without any obvious trigger
2. Secondary Frozen-Shoulder
Secondary frozen shoulder occurs as a consequence of another event or condition, such as:
- Shoulder injury: Fractures, rotator cuff tears, or surgery can lead to immobilization and subsequent frozen-shoulder
- Prolonged immobilization: Wearing a sling or avoiding movement after an injury or surgery
- Medical conditions:
- Diabetes mellitus (strongly associated with frozen-shoulder)
- Thyroid disorders (hypothyroidism or hyperthyroidism)
- Cardiovascular diseases
- Parkinson’s disease
- Inflammatory conditions: Tendinitis, bursitis, or arthritis affecting the shoulder joint
How Frozen Shoulder Develops
The shoulder capsule becomes inflamed and develops scar tissue (adhesions). This inflammation thickens the capsule and narrows the joint space, restricting movement and causing pain. The exact trigger for this process is unclear, but immune responses and metabolic factors may play a role.
Types of Frozen Shoulder
Frozen shoulder can be categorized based on cause and duration:
1. Primary (Idiopathic) Frozen-Shoulder
- Occurs without known cause
- More common in middle-aged adults, especially women aged 40–60
2. Secondary Frozen-Shoulder
- Develops following trauma, surgery, or illness
- Often linked with systemic diseases such as diabetes or thyroid disorders
3. Post-Surgical Frozen-Shoulder
- Develops after shoulder surgery or prolonged immobilization
- Usually a complication of rotator cuff repair or shoulder arthroscopy
Diagnosing Frozen Shoulder
Frozen shoulder diagnosis relies on a thorough clinical examination, patient history, and sometimes imaging studies.
Medical History
Your doctor will ask about:
- Duration and progression of shoulder pain and stiffness
- Any previous shoulder injuries or surgeries
- Medical conditions like diabetes or thyroid disease
- Impact on daily activities
Physical Examination
The key clinical features include:
- Restricted active and passive range of motion in the shoulder
- Pain with movement, especially during external rotation and abduction
- Tenderness over the shoulder joint
Range of Motion Tests
- The doctor assesses movements such as lifting your arm overhead, reaching behind your back, and rotating your arm outward and inward.
- In frozen-shoulder, passive movements are restricted, unlike other shoulder conditions where passive movements are usually preserved.
Imaging Studies
- X-rays: Usually normal but help rule out arthritis or fractures
- MRI (Magnetic Resonance Imaging): Can detect inflammation, thickening of the capsule, or other shoulder pathologies
- Ultrasound: May be used to assess rotator cuff tendons and bursae
Treatment of Frozen Shoulder
Frozen shoulder treatment aims to reduce pain, restore range of motion, and improve function. Treatment varies depending on the stage and severity of the condition.
1. Non-Surgical Treatments
Most cases of frozen-shoulder improve with conservative management.
Pain Management
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Ibuprofen, naproxen to reduce pain and inflammation
- Analgesics: Acetaminophen or prescription pain medications in severe cases
Physical Therapy
- Gentle stretching and range-of-motion exercises are key to preventing further stiffness
- Physical therapy should be tailored to the stage of frozen-shoulder:
- Freezing stage: Focus on pain relief and gentle movement
- Frozen stage: More aggressive stretching and strengthening exercises
- Thawing stage: Functional exercises to regain strength and mobility
Corticosteroid Injections
- Injection of corticosteroids into the shoulder joint can reduce inflammation and pain
- Often used in the early stages to facilitate physical therapy
Heat and Cold Therapy
- Applying heat before exercises helps relax muscles
- Cold packs after activity reduce inflammation and pain
2. Surgical Treatments
Surgery is considered when non-surgical treatments fail after 6-9 months and severe stiffness persists.
Manipulation Under Anesthesia (MUA)
- The shoulder is moved forcefully while the patient is under anesthesia to break adhesions
- This can quickly improve range of motion but carries risks like fractures or dislocations
Arthroscopic Capsular Release
- Minimally invasive surgery where the tight capsule is cut and released using a small camera and instruments
- Allows direct visualization and treatment of the joint capsule
- Followed by intensive physical therapy
Open Surgery
- Rarely needed, used only in severe or complicated cases
Rehabilitation and Recovery
Recovery from frozen shoulder can be slow and requires patience. A consistent rehabilitation program is crucial for regaining full function.
- Physical therapy typically continues for months after symptoms improve
- Home exercises complement therapy sessions
- Avoiding prolonged immobilization is essential
- Most patients regain 80-90% of shoulder motion
Risk Factors for Frozen Shoulder
Certain factors increase the likelihood of developing frozen shoulder:
- Age: 40-60 years
- Gender: Women are more commonly affected
- Diabetes: Up to 20% of diabetics may develop frozen-shoulder
- Thyroid Disorders
- Heart Disease
- Prolonged Shoulder Immobilization
- Previous Shoulder Injury or Surgery
Prevention Tips for Frozen Shoulder
- Avoid prolonged immobilization after shoulder injury or surgery
- Perform gentle shoulder exercises to maintain mobility
- Manage underlying conditions such as diabetes and thyroid disease
- Early medical consultation if shoulder pain and stiffness begin
When to See a Doctor
- Persistent shoulder pain lasting more than a few weeks
- Gradual loss of shoulder motion
- Difficulty performing daily activities
- Pain that worsens at night or with movement
Early diagnosis and treatment can prevent long-term disability.
Conclusion
Frozen shoulder is a painful and disabling condition that primarily affects middle-aged adults and those with certain medical conditions. It develops in stages, with progressive stiffness and pain. Although the exact cause is not fully understood, effective treatment options exist ranging from physical therapy and medications to corticosteroid injections and surgery.
If you suspect you have frozen-shoulder, seek medical advice promptly. With proper care and rehabilitation, most people recover substantial shoulder mobility and resume their normal activities.
Frequently Asked Questions (FAQS) About Frozen Shoulder
What is frozen shoulder?
Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful, restricting movement due to inflammation and tightening of the shoulder capsule.
What are the early symptoms of frozen shoulder?
Early symptoms include dull, aching shoulder pain, especially at night, and gradually increasing stiffness that limits the ability to move the arm.
What causes frozen shoulder?
Frozen shoulder can develop without a clear cause (idiopathic) or secondary to injuries, surgeries, prolonged immobilization, or medical conditions like diabetes and thyroid disorders.
Who is most at risk of developing frozen shoulder?
People aged 40-60, women, diabetics, those with thyroid problems, and individuals who have had shoulder injuries or surgeries are at higher risk.
How long does frozen shoulder last?
Frozen shoulder usually lasts between 1 to 3 years, progressing through freezing, frozen, and thawing stages, with gradual improvement over time.
Can frozen shoulder heal on its own?
Yes, frozen shoulder often improves without surgery, but recovery can be slow. Early treatment and physical therapy help speed up healing and reduce stiffness.
How is frozen shoulder diagnosed?
Diagnosis is primarily based on medical history and physical examination showing restricted active and passive shoulder movements. Imaging tests like X-rays or MRI may be used to rule out other conditions.
What is the difference between frozen shoulder and rotator cuff injury?
Frozen shoulder involves stiffness and restricted passive movement, while rotator cuff injuries cause pain and weakness but usually allow passive motion.
Are corticosteroid injections effective for frozen shoulder?
Yes, corticosteroid injections can reduce inflammation and pain, especially in the early stage, helping improve mobility alongside physical therapy.
What role does physical therapy play in frozen shoulder treatment?
Physical therapy is essential for restoring motion and strength through guided stretching and exercises tailored to each stage of the condition.
When is surgery recommended for frozen shoulder?
Surgery is considered if symptoms persist beyond 6-9 months despite conservative treatment and include options like arthroscopic capsular release or manipulation under anesthesia.
Can diabetes make frozen shoulder worse?
Yes, people with diabetes have a higher risk of developing frozen shoulder, and their recovery may take longer compared to non-diabetics.
Is frozen shoulder painful during all stages?
Pain is usually worst in the freezing stage, lessens during the frozen stage, and gradually subsides in the thawing stage as mobility improves.
How can I prevent frozen shoulder?
Avoid prolonged shoulder immobilization after injury or surgery, maintain regular shoulder exercises, and manage underlying conditions like diabetes and thyroid disorders.
When should I see a doctor for shoulder pain?
If shoulder pain lasts more than a few weeks, worsens at night, limits your daily activities, or you notice progressive stiffness, seek medical evaluation promptly.
For more details keep visiting our Website & Facebook Page.