Frozen Shoulder

ANATOMY OF THE SHOULDER

The shoulder is a ball and socket joint consisted of your arm (humerus) and the shallow socket of the shoulder blade (scapula). 


The capsule is consisted of ligaments which hold this ball and socket in place. 


Capsule wrapping around the ball & socket joint

This is also a fluid called synovial fluid inside the capsule to lubricate  joint surfaces.

WHAT IS FROZEN SHOULDER?

Also known as adhesive capsulitis, Frozen Shoulder is a condition which restricts movement of the ball and socket joint.   It is caused by adhesions of the joint capsule.  If the capsule is tight, the movement of the ball and socket joint will naturally be restricted causing pain and decreased functional range of motion.


WHAT IS THE CAUSATION OF FROZEN SHOULDER?

For majority of cases,   the cause is idiopathic which means the cause is unknown.   Statistically,  the condition is more prevalent in women than men between 40-60 years of age.    There is also no known prevalence between dominant vs non-dominant arm.

In minority of cases (i.e. 10%),   frozen shoulder might be triggered by long periods of immobility in the shoulder joint because of other medical conditions.   For example,  fracture of the arm bone (humerus) with immobilization of the shoulder or  waking up from a coma after months of immobility in hospital.

symptoms of frozen shoulder

  • Gradual onset of pain in shoulder with no known injuries
  • Location of pain can be non-specific and broad such as “inside the shoulder” or “down the arm”
  • Shoulder pain is usually identified by patient when he/she began to experience difficulty with physical activities such as:
    1.  Reaching behind back
    2. Putting on bra
    3. Reaching overhead
    4. Putting on jacket
  • In some patients,  pain can be quite severe with disturbance in sleep

IS DIAGNOSTIC IMAGING USEFUL? 

 X-rays and diagnostic ultrasound cannot visualize frozen shoulder because the condition is due to restriction or tightness of the capsule.    However,  because Osteoarthritis of the shoulder can have similar clinical presentation as frozen shoulder,   a plain x-ray with normal findings can rule out osteoarthritis thereby helping to confirm the diagnosis of frozen shoulder.

TREATMENT OPTIONS 

There is no fast and quick way to loosen up frozen shoulder.     Focus of treatment is consistent stretching and range of motion exercises.    As the shoulder capsule begins to loosen up, restriction of the ball and socket joint will be less.  If there is less restriction in movement (i.e. the joint not getting stuck), pain in the shoulder will also lessen.   Therefore, recovery is gradual.


IS INJECTION HELPFUL?

Cortisone injection is given outside the ball/socket joint and the capsule.  Although cortisone is a steroid with potent anti-inflammatory effect,  it cannot loosen the capsule.    Therefore, injection, at most, can help with the pain but not the restriction in movement.      Despite this,   for those with are in severe pain,   injection might still be helpful to alleviate some of the pain so that there will be more effective stretching and range of motion exercises.

HOW LONG DOES IT TAKE TO “UNFREEZE” THE SHOULDER?

Loosening of the shoulder joint varies from one person to another and is dependent on factors such as:   a) severity of restriction,   b) entry point of treatment during different phases of frozen shoulder (painful stage -> adhesive stage -> thawing stage), and c) compliance with home exercises and physiotherapy. 

Although the rate of recovery is individualized, it’s safe to say that progress will be gradual as the capsule needs time and consistent stretches to loosen up.     Therefore,  patience and commitment in physiotherapy and therapeutic exercises is required.    Your shoulder will not loosen up overnight.