-Cyprus Orthopaedics

Frozen Shoulder

Frozen shoulder is a painful condition of the shoulder, which commonly affects individuals in the 5th or 6th decades of life. The condition, which is also known as “adhesive capsulitis” or “shoulder contracture”, usually commences with an insidious onset of pain in the shoulder. Occasionally the pain may follow an injury to the shoulder. In the early phase of the disease, pain is experienced with movements of the shoulder and is often present day and night. Some time after the onset of pain, patients will start experiencing stiffness in the shoulder.
Shoulder Conditions-Cyprus Orthopaedics

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It occurs when the tissues around the shoulder joint become inflamed and thickened, resulting in limited mobility and discomfort. The exact cause of frozen shoulder is still unclear, but it often develops gradually and can last for several months or even years.

Causes of frozen shoulder

The exact cause of frozen shoulder is not fully understood. However, there are several factors that can increase the risk of developing this condition. One possible cause is an injury or trauma to the shoulder, which can lead to inflammation and subsequent freezing of the joint. Other underlying medical conditions such as diabetes, thyroid disorders, and heart disease have also been linked to the development of frozen shoulder. Additionally, prolonged immobilization of the shoulder joint, such as after surgery or during recovery from a fracture, can contribute to the development of this condition.

Risk factors for frozen shoulder

Certain factors can increase the risk of developing frozen shoulder. Women are more likely to be affected than men, and the condition usually occurs between the ages of 40 and 60. People with diabetes are also at a higher risk of developing frozen shoulder, as the condition is more common in individuals with this metabolic disorder. Other risk factors include thyroid disorders, heart disease, and a history of shoulder injuries or surgeries.

Symptoms of frozen shoulder

The primary symptom of frozen shoulder is pain and stiffness in the shoulder joint. Initially, the pain may be mild and gradually increase over time. The stiffness can make it challenging to perform everyday activities, such as reaching overhead or behind the back. The pain and stiffness typically worsen at night, making it difficult to find a comfortable sleeping position. In some cases, the range of motion in the shoulder may be severely limited, making it impossible to move the arm beyond a certain point.

Stages of frozen shoulder

Frozen shoulder progresses through three distinct stages: freezing, frozen, and thawing. The freezing stage is characterized by gradually increasing pain and stiffness. This stage can last for several weeks to months. The frozen stage is when the pain may begin to subside, but stiffness remains, and the range of motion is severely limited. This stage can last for several months to years. Finally, the thawing stage is when the shoulder gradually regains its range of motion, and the pain and stiffness diminish. This stage can last for several months to years as well.

Diagnosing frozen shoulder

To diagnose frozen shoulder, an orthopedic surgeon will typically perform a physical examination and review the patient’s medical history. They will assess the range of motion in the shoulder joint and look for signs of inflammation or thickening of the tissues. In some cases, imaging tests such as X-rays or MRI scans may be ordered to rule out other underlying conditions, such as a rotator cuff tear or arthritis.

Treatment options for frozen shoulder

There are several treatment options available for frozen shoulder, depending on the severity of the condition. In the early stages, conservative approaches such as physical therapy and pain management may be recommended. Physical therapy exercises aim to improve range of motion and strengthen the muscles surrounding the shoulder joint. Pain management techniques may include over-the-counter pain relievers or corticosteroid injections to reduce inflammation and provide temporary relief.

Physical therapy exercises for frozen shoulder

Physical therapy exercises are an essential part of the treatment for frozen shoulder. These exercises aim to improve range of motion, strengthen the muscles, and reduce stiffness. Some common exercises include pendulum swings, shoulder stretches, and rotator cuff exercises. It is crucial to perform these exercises under the guidance of a qualified physical therapist to ensure proper technique and prevent further injury.

Medications for frozen shoulder

In some cases, medications may be prescribed to manage the pain and inflammation associated with frozen shoulder. Over-the-counter pain relievers such as ibuprofen or acetaminophen can provide temporary relief. If the pain is severe, corticosteroid injections may be administered directly into the shoulder joint to reduce inflammation and provide more significant pain relief.

Surgical options for frozen shoulder

In rare cases where conservative treatments do not provide sufficient relief, surgical intervention may be considered. There are two main surgical options for frozen shoulder: manipulation under anesthesia and arthroscopic release. Manipulation under anesthesia involves forcefully moving the shoulder joint to break up adhesions and improve range of motion. Arthroscopic release is a minimally invasive procedure where the surgeon cuts through the tight tissues surrounding the shoulder joint to release the stiffness.

Preventing frozen shoulder

While it may not be possible to prevent frozen shoulder entirely, there are steps you can take to reduce the risk. Regular shoulder exercises and stretching can help maintain flexibility and prevent stiffness. Avoiding prolonged immobilization of the shoulder joint, especially after surgery or injury, is also crucial. If you have any underlying medical conditions such as diabetes or thyroid disorders, managing them effectively can help reduce the risk of developing frozen shoulder.

The condition of Frozen shoulder often follows a protracted course. Pain, which is often severe and constant in the early phase of the disease, tends to diminish in intensity with time leaving the shoulder stiff. The course of the disease is variable with some patients recovering quickly, some slowly and some very slowly. A number of studies have demonstrated that, left untreated, more than 50% of patients will have residual symptoms upto 5 years after the onset of symptoms.

Frozen shoulder is a condition, which affects the capsule (or sleeve) of the joint. The capsule becomes inflamed and subsequently thickened and scarred leading to restriction of movements. In most cases there is no specific cause but the condition may be associated with diseases such as diabetes, heart disease and some neurological disorders. In some instances frozen shoulder may develop following an injury or after surgery.

A diagnosis of frozen shoulder is made based on the history of a painful, stiff shoulder and difficulty reaching sideways, up or behind the back. Examination shows significant limitation of movements of the shoulder in all directions. An X-ray can be helpful to exclude other pathology and is usually normal. An ultrasound scan may be performed to check the state of the rotator cuff. Special imaging with MRI or CT scans is rarely necessary.

Steroid injections: In the early phase of the disease pain may be difficult to control with tablets alone. Steroid injections, placed accurately into the joint, have been shown to be very effective in relieving pain in the early phase of the disease and may be repeated on 2 or 3 occasions until the pain has subsided. For further information on steroid injection in the shoulder click here.

Hydrodilatation: This involves injecting a mixture of local anaesthetic, steroid and saline into the joint under x-ray or ultrasound guidance. It may be effective in alleviating pain and enabling patients to have physiotherapy to regain movements.

Physiotherapy: When the constant pain has resolved, stiffness may be overcome to some extent by supervised physiotherapy directed at progressive stretching of the capsule. Stretching exercises should be performed in all directions to achieve maximum benefit.

The British Elbow and Shoulder Society (BESS) video on frozen shoulder has useful guidance and exercises for patients with frozen shoulder.

Surgery: In some instances when the stiffness is severe or if it should fail to respond to physiotherapy then it may be appropriate to undertake surgical treatment. This consists of arthroscopic or “key-hole” surgery to circumferentially release and remove parts of the capsule to restore movements. If there is associated pathology such as impingement then this can be treated at the same time. This is then followed up with physiotherapy to maintain the improvement in the range of movements that has been achieved at surgery. For further information on surgical treatment, please refer to the procedures section.

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