What is a Frozen Shoulder? 

A frozen shoulder, or adhesive capsulitis, is a condition that causes the shoulder to become stuck in one place. It happens when the connective tissue surrounding the shoulder, which keeps all its components together, becomes thick, restricting shoulder movement. 

The causes of frozen shoulder are not quite known. The condition usually starts mildly but can progress to become quite painful, requiring frozen shoulder treatment.

Anatomy of the Shoulder

Our shoulder is a joint where three bones come together: the upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). These three bones are held together by the shoulder capsule. When the tissue of the shoulder capsule becomes inflamed, the capsule thickens, leaving little room for the shoulder bones to move.

The result is a stiff and painful shoulder joint. Because using the shoulder becomes increasingly unbearable, its movement is resisted, causing it to become even more stuck. Ordinary tasks like getting dressed can become increasingly challenging and painful.  

Frozen Shoulder Symptoms

The most common symptoms of a frozen shoulder are severe pain, stiffness and limited range of shoulder movement. The condition can present in both shoulders but not usually at the same time.

Sure signs of a frozen shoulder are difficulty with routine tasks like:

• Dressing and undressing
• Taking a bath
• Getting in and out of a car and driving
• Getting something from a top shelf
• Taking hold of something slightly out of reach

Symptoms are categorised into three stages according to their severity. These stages and their duration are not the same for all patients.

What Causes Frozen Shoulder?  

Research has not identified clear causes for frozen shoulder, but health experts have singled out risk factors for developing the condition. These include:

• Age and gender – people older than forty are more likely to develop frozen shoulder which is more common among women than men.
• Neglecting physical exercise after an injury or a bout of shoulder tendinitis. 
• Prolonged forced immobility of the shoulder due to an injury or surgery.
• Immobilising the shoulder in a sling for days and leaving it like that.
• Rotator cuff problems can cause a frozen shoulder.
• Certain health conditions, including thyroid disorders, diabetes, Parkinson's disease, and tuberculosis.

Frozen Shoulder Stages

Stage 1

Stage 1 is referred to as the "freezing" stage. During this stage, stiffness in the shoulder sets in with an accompanying increase in pain. The shoulder becomes harder to move. This stage, like the others, varies from patient to patient, lasting from six weeks to nine months.

Stage 2

This is the so-called "frozen" stage. During this stage, the shoulder becomes almost totally immobilised, making routine tasks and daily activities very challenging, even impossible at times. The pain level stays mostly the same. This stage continues for two to twelve months.

Stage 3

Referred to as the "thawing" or recovery stage, this is when things start getting better. The stiffness eases, and the pain gradually dissipates. The individual gradually regains movement of the shoulder. Recovery takes place over some months. Full recovery can take up to two years.

Treatment for a frozen shoulder during all these stages is necessary to ensure timely and effective recovery.

How Is a Frozen Shoulder Diagnosed?

To diagnose your condition, a shoulder pain specialist will ask questions about your symptoms and carry out a physical exam. After discussing your symptoms, the doctor will test your active and passive range of movement.  

• The doctor will ask you to move your shoulder and arm to determine your range of movement – your active range of movement.
• The doctor will move your arm to see how far it will go in any direction, testing your passive range of motion.

If both types of motion are limited, a frozen shoulder diagnosis will be made. The doctor may order advanced imaging tests like magnetic resonance imaging (MRI) and ultrasound to confirm or eliminate other issues, such as arthritis or a rotator cuff tear. Typically, such tests are not necessary for a frozen shoulder diagnosis.

Treatment for Frozen Shoulder 

The treatment for frozen shoulder in Singapore comprises conservative options as well as surgical treatment options. Read more about other types of shoulder pain treatment by our orthopaedic doctor here.

Non-Surgical Treatments

After the condition is diagnosed, a shoulder pain doctor typically starts with non-surgical treatment for frozen shoulder, which may include the following modalities.

Pain Management

In the initial phases, frozen shoulder treatment focuses on pain relief. Your doctor may prescribe anti-inflammatory medication such as aspirin, ibuprofen, and others to relieve inflammation, swelling, and pain. 

Steroid injections

Your doctor may prescribe powerful anti-inflammatory medicines such as cortisone, which are injected directly into the painful area to reduce inflammation. In many cases, these injections can lead to fast recovery.

Heat treatment

The tight shoulder muscles may relax when heat is applied. The heat will also help to restore mobility.

Physiotherapy

Physical exercises for frozen shoulder are essential to help restore movement and rebuild muscles. Your physical therapist will introduce you to exercises that target the shoulder and facilitate its mobility. These include exercises that improve range of motion and stretch the tissue of the shoulder capsule. 

When the shoulder becomes more flexible, strengthening exercises are introduced to help restore the shoulder to its former capacity. 

Initially, you will need to perform these exercises under the supervision of your physical therapist. When you have mastered them, you can continue exercising at home. 

Joint Distension

Joint distension is a procedure that stretches the joint capsule, making shoulder movement easier. The stretching happens as a result of injecting sterile water into the joint.

Shoulder Manipulation under General Anaesthetic

With the patient under anaesthesia, the surgeon manipulates the affected shoulder through a range of movements. The manipulation causes the tight shoulder joint capsule to stretch and tear, releasing the tightness and enabling smoother shoulder movement.

Surgical Treatment For Frozen Shoulder

Capsular Release Surgery

This frozen shoulder treatment involves keyhole surgery to ease the shoulder capsule. Doctors only resort to surgery if the shoulder doesn't respond to other less invasive treatments.  

During surgery, the surgeon makes three small incisions in the shoulder to access the capsule. The surgeon then inserts a special arthroscopic camera and surgical instruments to cut and remove any abnormal capsule tissue. Afterwards, the surgeon cauterises the cuts using radiofrequency waves to stem the bleeding. 

The incision sites are closed with sutures or surgical staples. Afterwards, you should experience a greater range of movement in your shoulder with reduced pain.

Alternative Treatments for Releasing a Frozen Shoulder 

There are several treatments you can use at home to relieve a shoulder that won't budge. In addition to heat packs, taking an Epsom salt bath may also help soothe stiff muscles.  

Massage is a proven technique for the relief of sore and stiff muscles. Massage by a physiotherapist trained in massage techniques can release tight muscles and reduce pain. Massage won't heal the frozen shoulder, but it will bring relief.

Other alternative treatments that may bring relief include Ayurveda and acupuncture. 

Recovery Time

After looking at all the treatment possibilities, what is the best treatment for frozen shoulder? There is no clear answer. Treatment options for frozen shoulder differ from case to case and your doctor is the best judge of how to treat it.

Two things are sure, though. Most people recover completely; it just takes time. Recovery times vary enormously. Some cases resolve within months, while others can take up to three years.