Frozen Shoulder

What is a Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a common condition caused by inflammation of the joint capsule, a connective tissue covering the shoulder joint. This inflammation often leads to thickening and tightening of the capsule, resulting in pain and restriction of joint motion.

What Are the Causes of Frozen Shoulders?

While frozen shoulders can manifest following periods of immobilization post-injury, such as sprain, tendon injury, tear, shoulder fracture, or surgery, a considerable portion of cases arises without a clear precipitating event. Despite ongoing research, the precise triggers remain elusive. However, certain factors such as age, gender (with women being more susceptible), diabetes, and thyroid disorders are commonly associated with its development.

What Are the Symptoms of Frozen Shoulder?

Frozen shoulder typically presents with varying degrees of pain, dull achiness, and stiffness of the joint. These symptoms can significantly affect sleep and daily activities. Frozen shoulder typically goes through three phases:

a) Freezing phase: This initial phase is often painful and may last up to 9 months.

b) Frozen phase: Pain improves, but movements become more restrictive.

c) Thawing phase: Pain and movements gradually improve and may last up to 24 months.

How is it Diagnosed?

Frozen shoulder can be diagnosed by your doctor after checking your symptoms and performing a shoulder examination. Radiological imaging, such as X-rays is required to differentiate frozen shoulders from other causes of shoulder pain and stiffness, such as osteoarthritis. 

Advanced imaging modalities such MRI, might sometimes be required to look for other underlying pathologies such as rotator cuff tears.

​What Are the Treatments for Frozen Shoulder?

The cornerstone of frozen shoulder management revolves around physiotherapy and pain management. A tailored exercise regimen, focusing on stretching and restoring range of motion, proves highly beneficial. Initially guided by a physiotherapist, these exercises can later be continued at home.

Additionally, interventions like steroid injections and hydrodilatation, conducted under X-ray guidance, aim to alleviate inflammation and expand the joint space by stretching the capsule.

Do I Need Surgery?

For some individuals with frozen shoulder, conservative treatments may not provide sufficient relief, and surgical intervention may be necessary to improve symptoms and restore shoulder function. Surgical options for frozen shoulder typically aim to release the tight capsule and adhesions, allowing for improved joint mobility and range of motion.

The surgical approach typically involves minimally invasive procedures such as arthroscopic capsular release and manipulation under anesthesia (MUA). During the procedure, the surgeon makes small incisions around the shoulder joint and inserts a tiny camera (arthroscope) and specialized surgical instruments to access the joint space.

Using the arthroscope for visualization, the surgeon carefully releases tight ligaments and adhesions within the shoulder capsule, allowing for improved mobility and range of motion. Arthroscopic capsular release offers several advantages over traditional open surgery, including smaller incisions, less post-operative pain, and faster recovery times.

This is typically followed by MUA, which involves manipulation of the shoulder joint while the patient is under general anesthesia, allowing the surgeon to break up adhesions and scar tissue that restrict joint movement.

Following MUA, patients typically undergo a period of post-operative rehabilitation to maintain joint mobility and prevent the reformation of adhesions. While MUA can be effective in restoring shoulder mobility, there is a risk of complications such as fractures or soft tissue injuries, and careful patient selection and techniques are essential.

Recovery and Rehabilitation

Following surgical intervention for frozen shoulder, patients typically undergo a period of post-operative rehabilitation to optimize outcomes and restore shoulder function. Physical therapy plays a crucial role in the recovery process, focusing on gentle stretching exercises, joint mobilization techniques, and progressive strengthening exercises to improve range of motion, muscle strength, and functional abilities.​Recovery times can vary depending on the severity of the frozen shoulder and the type of surgical procedure performed. Most individuals can expect to experience gradual improvement in symptoms over several weeks to months following surgery, with diligent adherence to the prescribed rehabilitation program.​

Conclusion

Frozen shoulder, though challenging, can be effectively managed through a combination of conservative treatments and, when necessary, surgical interventions. By understanding its underlying mechanisms and embracing appropriate therapeutic modalities, individuals can embark on a journey towards recovery and restored shoulder function.​If you suspect you may be experiencing symptoms of frozen shoulder, we encourage you to consult with a healthcare professional for a thorough evaluation and personalized treatment plan.