Frozen Shoulder: Diagnosis and Treatment

What is Frozen Shoulder?

Frozen Shoulder also known as Adhesive Capsulitis or Periarthritis is a condition characterised by pain and stiffness of the shoulder joint. To break the myth, frozen shoulder is the development of capsular restrictions, rather than arthritic changes in the bone or cartilage that occurs with Osteoarthritis or Rheumatoid Arthritis. The capsule thickens and tightens with a frozen shoulder, making it difficult to move. Scar tissue develops in the joint, and synovial fluid, which keeps the joint lubricated, is reduced. These things make it much more difficult to move.

There is no known cause of frozen shoulder, hence it is called idiopathic. Although disorders in which there is prolonged pain and restricted motion such as trauma, immobilization, RA or OA  may lead to secondary frozen shoulder. The pathogenesis for primary frozen shoulder can be a chronic musculotendinous or synovial tissue inflammation, such as the biceps tendon, rotator cuff or the joint capsule. People with diabetes mellitus and thyroid are at a higher risk of developing this disorder. The onset of Frozen Shoulder is gradual and it generally occurs between the ages of 40 and 65 years.

Stages of Frozen Shoulder

This clinical disorder progresses in a series of four stages. Each stage follows a continuum and can last a number of months.

• Stage 1: The duration of this stage is less than 3 months. The onset is gradual and the pain increases with movement and at night time.
• Stage 2: Referred to as “Freezing Stage.” The duration of this stage is between 3 and 9 months after onset. The pain is more intense even at rest. The shoulder range of motions gets limited in all directions.
• Stage 3: Referred to as “Frozen Stage.” The duration of this stage is between 9 and 15 months after onset. The pain occurs with movement. However, pain starts to diminish in this stage.  The shoulder becomes stiffer and movement becomes difficult.
• Stage 4: Referred to as “Thawing Stage.” The duration of this stage is between 15 to 24 months after onset. The pain is minimal and the shoulder motions gradually improve during this stage.

Common impairments of functions and structures in Frozen Shoulder

• Night pain and disturbed sleep.
• Pain on motion and at rest.
• Reduced mobility: Inability to reach overhead, behind the back, difficulties in dressing (wearing a shirt), reaching hands in the pant’s back pockets, self-grooming (combing hair, brushing teeth), etc.
• Difficulties lifting objects beyond shoulder level.
• Posture: Faulty posture compensations (protracted shoulders, or guarding the painful shoulder in elevation and adduction).
• Glenohumeral muscle weakness.
• Limitations to sustain repetitive movements.

Diagnosis

The doctor will perform a physical examination to diagnose a frozen shoulder. They’ll examine it to see how painful it is and the pain-free range of motion. Both active (with the patient’s effort) and passive (with the help of the doctor) motions will be checked.

The doctor may decide if an anaesthetic injection is needed for the shoulder. This is a pain reliever that will make it easier for them to assess your active and passive ranges of motion.

Frozen Shoulder Treatment

The treatment may include NSAID’s that helps relieve pain and inflammation. The treatment may also include physiotherapy (strengthening and stretching exercises) to improve the range of motion of the shoulder joint.

If the symptoms do not improve with time, the following treatments can be recommended.

• A corticosteroid injection: A corticosteroid injection to reduce pain and improve ROM.
• Joint dissection: Sterile water is injected into the shoulder capsule to stretch it which helps you move the shoulder easily.
• Physiotherapy: Strengthening and stretching shoulder girdle muscles to improve range of motion and pain reduction.
• Shoulder manipulation: It is rarely done as shoulder arthroscopy has taken over. It is performed under general anesthesia, the surgeon may manipulate the joint.
• Surgery: Surgery is rare in the frozen shoulder. But if other treatments do not help, an arthroscopic procedure may be needed.

Frozen Shoulder Prevention

Immobility that occurs as a result of a shoulder injury, a broken arm, or a stroke is one of the most prevalent causes of frozen shoulder. If you’ve suffered an injury to your shoulder that makes it difficult to move it, talk to your doctor about exercises you may follow to keep your shoulder’s range of motion.