What is Frozen Shoulder?

Frozen shoulder is the layman’s term for the medical condition known as adhesive capsulitis. It is a shoulder-specific condition that affects an overall range of motion, as well as causes some pain and discomfort. It is also commonly mis-associated with arthritis, although arthritis can be a risk factor in a frozen shoulder.

The Shoulder Joint

It is firstly important to understand the shoulder as a whole; meaning the bones and tissue that make up the shoulder itself.

The entire shoulder area is made up of 3 main bones: the collarbone (clavicle), shoulder blade (scapula) and upper arm (humerus). It is commonly understood that the shoulder functions using a ball and socket joint, where the clavicle and scapula come together to form the socket and the upper, rounded portion of the humerus forms the “ball” and fits into it.

Fig 1: An inside look at a normal shoulder and a frozen shoulder

Surrounding the entire shoulder joint is also connective tissue that holds the entire joint in place. This tissue is known as the shoulder capsule.

Causes and Risk Factors of Frozen Shoulder

When the aforementioned shoulder capsule tissues become inflamed, shrinks, thickens or scars, it results in a frozen shoulder. This is a direct cause of the entire joint being constricted and not having enough space for free range of movement.

There are a number of reasons encouraging this phenomenon. The first of which is injuries from sports or overexertion. Conditions like tendonitis or a rotator cuff injury can contribute to the damage sustained by the shoulder capsule, subsequently causing a frozen shoulder.

Secondly, pre-existing medical conditions contribute to frozen shoulder development too. 10 to 30% of patients suffering from diabetes are known to have also contracted frozen shoulder[1]. Other conditions that can cause frozen shoulders are heart disease or Parkinson’s Disease.

Lastly, long-term immobility of the shoulder can lead to frozen shoulders too. For example, someone who has had surgery and has to keep the shoulder casted or non-moving for weeks or months on end will be more likely to encounter frozen shoulder.

Symptoms of Frozen Shoulder

The hallmark symptoms of frozen shoulder is of course pain and stiffness in the shoulder. Sometimes this pain can extend up to the muscles in between the neck and shoulder, or at the area around the upper arm. Symptoms generally spam over 3 stages:

The Freezing Stage

This stage mostly encapsulates the development of pain and stiffness. Pain can escalate and become severe, especially at night, but stiffness is still minor. This stage can last 6 to 9 months.

Frozen Stage

Pain in the shoulder gradually begins to get better, but stiffness is the real issue in this stage. Range of motion becomes even more limited and daily activities can be a chore to carry out. This stage can last from anywhere between 4 to 12 months.

Thawing Stage

Also known as the recovery stage, this is when the complete range of motion and flexibility of the shoulder starts to return to normal. Although this might be a good turn of events, this stage can take exceedingly long, from 6 months to 2 years.

Treatment and Prevention

Methods of treating a frozen shoulder commonly revolve around over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs, painkillers), such as aspirin or ibuprofen. These can work to reduce pain levels and lessen inflammation in the shoulder, hopefully restoring some measure of movement.

Usually, such medication is used in tandem with physical therapy, which encourages regular exercise of the joint to prevent stagnation. In addition, the physiotherapist can also introduce electrical stimulation and help a patient stretch the shoulder, all of which helps ease the symptoms of frozen shoulder.

In rarer, more serious cases where symptoms do not get better after prolonged medication administration and physiotherapy, surgery is then brought into consideration.

Arthroscopic Surgery is the most common kind of surgery when it comes to issues with joints, such as frozen shoulders. This involves the doctor using an arthroscope, a thin tube with a camera and light at the end, and inserting it into the shoulder joint to look around inside and conduct the surgery.

The surgery itself aims to break up the scar tissue in the shoulder capsule, releasing pressure and space around the joints, relieving pain and granting greater shoulder flexibility. It should be noted, however, that this kind of surgery carries the risk of breaking (fracturing) the humerus.

Shoulder Exercises

Should you begin to feel stiffness or pain in your shoulder and wish to combat it early, here are some simple exercises you can engage in 5-10 times a day to help. Remember to always warm up before starting the exercise by taking a warm shower or bath, and also do the stretches to the point of tension but without the pain.

Cross Body Stretch

A simple exercise that many do simply to warm up before sports. Extend your injured arm across your body, reaching for the opposite side, and use your good arm to support it from below. Pull back using the supporting arm until you feel the tension, and hold the stretch for 15 seconds.

[1] https://www.diabetesnet.com/about-diabetes/diabetes-complications/frozen-shoulder-in-diabetes/

● Finger Wall Walk

While making sure your affected arm is bent at a 90 degree angle at the elbow, face a wall and approach it. Place 2 fingers on the wall, keeping your arm bent at the same time. Then begin to slowly “walk” your fingers up the wall, making sure to use your shoulder to do the work rather than your arm. Do this until you can feel the stretch and no pain, and then slowly lower your arm, using support if need be from your other arm.