Frozen Shoulder 101: Symptoms, Causes, Treatment & Prevention

Frozen shoulder or adhesive capsulitis is a type of shoulder pain that causes severe pain and stiffness. Find out the causes, symptoms and how to treat frozen shoulders at home.

by Calvyn Ee

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is when a person experiences pain and stiffness in their shoulder.

Over time, the affected shoulder may slowly become more restricted in its range of motion (ROM). After this period of worsening symptoms, it will slowly start to get better – a process that can take anywhere between one to three years.

Frozen shoulder is characterised by three stages, beginning with freezing, then frozen, and finally the thawing phase. It may usually occur if you or your loved one may have had a shoulder injury that prevents any shoulder movement for a significant amount of time. It can affect anyone at any stage in life.

Frozen shoulder commonly affects adult women between the age of 40 to 60 years old, though it can still happen to anyone. It also can affect those who have previously suffered a shoulder injury.

Symptoms of Frozen Shoulder

The symptoms differ for each of the three stages. In the first stage, freezing, pain is the most prominent symptom. The pain will gradually worsen and also becomes more limited in its ROM; you might feel pain frequently whenever you move your arm. The pain may also worsen at night or when you lie on the affected arm. It can last anywhere from two to nine months.

In the subsequent frozen stage, the pain slowly recedes but your shoulder’s ROM remains limited, making it difficult to perform daily activities. This stage can last anywhere between four to twelve months.

Finally, the thawing stage sees a slow return to form as your shoulder’s ROM is restored over time. By this point, only the pain has all but subsided. A full recovery can take between six months to two whole years.

Causes of Frozen Shoulder

Your shoulder is made up of three bones that, together, form a ball-and-socket joint: your upper arm bone (the humerus), the shoulder blade (scapula), and the collarbone (clavicle). Surrounding the joint is strong connective tissue called the shoulder capsule. The capsule is responsible for holding all these bones together and allows for shoulder movement. Synovial fluids, a thick liquid that is found between the joints, act as a lubricant to cushion the ends of bones (where they meet) while allowing joints to move smoothly.

Frozen shoulder occurs when the capsule becomes thick, leading to stiffening and also inflammation. Scar tissue, called adhesions, also begins to form, while less synovial fluid is present between the joints. All of these cause shoulder pain and reduce ROM over time. The reason why the condition is called “frozen shoulder” is because of the pain: the more pain you feel when you move your shoulder, the less likely you will move it. This lack of movement further worsens the pain and stiffness until it truly feels like it has “frozen” solid.

Why this happens, though, is still not fully understood. One possible theory is that not making use of the shoulder can cause the capsule to slowly become stiff, such as when you are recovering from a shoulder injury or surgery.

Risk Factors of Frozen Shoulder

Certain risk factors can potentially worsen the risk of developing a frozen shoulder.

These include (but are not limited to):

  • Reduced shoulder mobility (due to injury, surgery, etc.)
  • Diabetes
  • Recovery from a stroke
  • Hyper/hypothyroidism
  • Heart disease
  • Parkinson’s disease

Note that having any of these risk factors does not mean that you will develop the condition.

Diagnosing Frozen Shoulder

Your doctor will ask a few things about your health and current symptoms. They may perform a physical examination to check your shoulder’s current ROM, how much pain you feel from movement, and look for other complications. They may ask you to move your arm on your own first, before moving it themselves, and then compare the results. You might be given an anaesthetic to numb the pain so that the doctor can better determine your overall ROM.

They may also perform some additional tests, including X-ray imaging as well as MRI or ultrasound checks. These are useful to identify other symptoms that might be the actual cause of the pain and stiffness, such as arthritis.

Treating Frozen Shoulder

While a frozen shoulder does go away on its own without medical attention, it can take a very long time to fully recover from it. Treatment will vary based on the stage you are currently at.

When the pain is at its most severe, pain relief will be the primary treatment method. You may be prescribed painkillers such as aspirin or paracetamol to help ease the pain or inflammation. In some cases, stronger medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may be needed. However, taking painkillers may potentially increase the risk of side effects for a long-term period. 

Other treatment options include:

  • Steroid injections: The use of steroids like cortisone, injected directly into your shoulder joint, may help to reduce pain and inflammation, thereby improving shoulder mobility. This is not a one-time cure, as symptoms will gradually reappear. Once the pain is gone, these injections are no longer needed. Moreover, long-term use can potentially cause harmful side effects and become less effective with frequent use.
  • Hydrodilatation: This procedure involves injecting sterile fluid into the shoulder joint. This may help to expand and stretch the capsule, improving the shoulder’s ROM.
  • Physical therapy: Physiotherapy can be beneficial in restoring motion in the shoulder. A physiotherapist will help you with restoring shoulder movement with guided physical activities and even at-home exercises. Using hot or cold compresses can help reduce pain and swelling in the shoulder. Physiotherapy is generally employed in the frozen stage, though it can be used at any point to reduce the severity of symptoms.
  • Alternative medicine: Acupuncture is one alternative medicine option available to help with treating frozen shoulder.
  • Manipulation under anaesthetic: This procedure involves controlled shoulder movement by a doctor while you are under general anaesthetic. The doctor forces the shoulder to move, causing the capsule and scar tissue to stretch or tear to loosen the stiffness. While it can restore ROM, this procedure is considered risky as it can potentially cause complications like fractures.
  • Surgery: In rarer cases, surgery may be needed to address serious cases. Shoulder arthroscopy, also known as arthroscopic capsular release, is a commonly used minimally invasive procedure, where the doctor will make some small incisions around your shoulder and then insert an arthroscope to view the inside of the shoulder. A special probe inserted through the other incisions emits high-frequency radio waves, which can divide or cut out the thickened parts of the shoulder capsule, thus restoring ROM.

Treating It From Home

If you choose to treat it from home, you can purchase painkillers like aspirin and paracetamol to help with relieving any pain you or your loved one experiences. Be sure to take them only as indicated.

Home physiotherapy is the best way to facilitate a speedy recovery. You do not need to go to a dedicated physiotherapy unit/centre to get physical therapy. A physiotherapist can help you set up a schedule for activities to do that help you restore your shoulder’s ROM over time. You simply need to see them for an initial consultation, allow them to perform a routine physical examination (much like a doctor would), and then discuss a suitable plan that works best for you.

Treating frozen shoulder at home is a good way to recover from the comforts of a familiar environment. You will not even need to change up things too much to accommodate your increased physical activity. As long as you keep moving your shoulder (within reasonable limits) through simple ROM activities and exercises, you should be able to make good progress over time.

Massages can also be useful in reducing swelling and stiffness while promoting improved shoulder mobility over time. However, care must be taken so as to not put too much pressure on the affected shoulder. You could run the risk of worsening the capsule’s tightness, causing more pain and less relief. Consult your physiotherapist on what types of massages are beneficial, and when they should be employed for the best results.

Having a trained care provider who knows how to perform physiotherapy at home can also be very beneficial. That way, you can have someone monitor your progress, as well as offer advice on what to do or avoid, which ultimately leads to a full recovery in no time. They can also help you with daily activities around the house, especially when the frozen shoulder will prevent you from doing things properly. Having an extra hand can do wonders for your own self-esteem.

If you need help at home, we’re just a phone call away. Here at Homage, our trained care professionals are able to provide you and your loved ones with companionship, nursing care, night caregiving, home therapy and more. Contact us, and our friendly Care Advisory team will help you out in no time. Alternatively, fill up the form below for a free consultation with our team.


References
About the Writer
Calvyn Ee
Calvyn is an aspiring author, poet and storyteller. He spends his time reading, gaming and building stories with his action figure photography.
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