Frozen Shoulder : Causes, Types, Treatment and Symptoms

Frozen shoulder, also known as adhesive capsulitis, is a painful condition that causes significant stiffness and restricted movement in the shoulder joint. It usually develops gradually, worsens, and then slowly resolves over months or years, though early physical therapy is critical to avoid long-term limitations.

Most Common Frozen Shoulder Symptoms:

• Pain: Dull or aching pain in one shoulder, often radiating upwards, or may worsen at night.
• Rigidity: Prominent stiffness in the shoulder and loss of motion, rendering the shoulder impossible to move.
• Disrupts routine: Difficulty with grooming, dressing, or reaching behind the back and over the top.
• Sleep disturbances: Difficulty sleeping during the early and middle stages.
• Outward rotation of the shoulder is noticeably difficult.
• Delayed active and passive movements of the shoulder capsule.

Common, Uncommon or Underlying Causes of Frozen Shoulder

The exact cause of frozen shoulder is frequently unclear and can be multifactorial, but it can result from a variety of factors, such as systemic health conditions, injuries, or protracted shoulder immobility.

Here are some reasons for frozen shoulder:

• Restricted movements of the hands after an injury, surgery, stroke, or fracture for weeks to months.
• Poorly controlled diabetes
• Hypo and hyperthyroidism
• Inflammation from non-severe injuries, rotator cuff tendinitis, or bursitis
• Cardiac diseases of Parkinson’s disease may be the indirect causes, as these conditions invite prolonged bed rest.
• Postoperative complications after chest wall, breast, or open-heart surgery may trigger the frozen shoulder.
• Cervical disc disease of the neck.
• Autoimmune and inflammatory conditions may trigger an idiopathic cause.
• Persistent hyperglycemia in a diabetic patient.
• Prolonged hormonal imbalances.

When to Seek a Specialist for Your Frozen Shoulder?

If you are experiencing pain for weeks, observe challenges in your daily activities or movements, it is recommended that you seek a specialist consultation for frozen shoulder. It is crucial to conduct an early medical evaluation in order to exclude alternative causes and to enable immediate action with therapies such as injections or physical therapy, which may slow the condition’s progression and accelerate recovery.

• Persistent shoulder pain for more than 4 weeks
• Increased difficulty in moving arms or shoulders 
• Pain is severe enough to disrupt sleep and normal activities
• Lack of improvement after rest, heart therapy, or mild exercises
• Shoulder pain that stays even after treating the underlying causes

Don’t wait for signs to grow severe. Consult our Orthopedic Specialists today

Diagnostic Approach for Frozen Shoulder

Specialists propose a step-by-step, evidence-based strategy to treating frozen shoulder, focusing on pain management and gradual range of motion restoration, with therapy customized to the stage of the problem. The success and speed of rehabilitation are primarily reliant on patient engagement and persistent exercise, with invasive procedures only considered if function remains substantially reduced after several months.

• Strengthening exercises
• Movement-with-mobilization techniques
• Heat and cold therapy
• Certain medications
• Transcutaneous electrical wave stimulation: Relieves pain through a low-voltage electrical current.
• Acupuncture, dry needling, and muscle release.
• Hydrodilatation: A pressure of sterile water stretches the capsule to improve function.
• Muscle manipulation under anesthesia (MUA).
• Arthroscopic capsular release surgery: Removes adhesion and improves function.

Types of Frozen Shoulder

Frozen shoulder is initially classified based on its origin as well as the presence of any related systemic or shoulder problems, which is critical for guiding diagnosis, prognosis, and therapeutic procedures.

Some common types of Frozen Shoulder include:

• Primary frozen shoulder: No apparent cause
• Secondary frozen shoulder:
  – Systemic – Diabetes mellitus, hypothyroidism, hyperthyroidism, and hypoadrenalism
  – Intrinsic – Rotator tendinitis, rotator cuff tear, biceps tendinitis, calcific tendinitis, and AC arthritis
  – Extrinsic – Cardio pulmonary disease, cervical disc, humerus fractures, and parkinson’s
• Based on irritability level:
  – Low
  – Moderate
  – High
• Based on the symptoms and histology:
  – Pre-adhesive
  – Freezing
  – Thawing

How to Treat Frozen Shoulder Symptoms?

The treatment for frozen shoulder is to reduce discomfort, restore range of motion, and optimize function. This is normally accomplished by a mix of medication management, physical therapy, and home care, with specialized procedures or surgery reserved for chronic problems.

For underlying causes, treatments & rehabilitative strategies include:

• Certain prescribed medication
• Physical therapy
• Corticosteroid injection to reduce joint inflammation and improve mobility
• Regular, gentle exercises are performed several times a day
• Avoid sudden jerking movements
• A gentle massage with warm oil and a bath in Epsom salt helps relax and relieve symptoms

What if Frozen Shoulder is Left Untreated?

If left untreated, frozen shoulder can cause chronic discomfort and stiffness, potentially leading to irreversible loss of shoulder function and significant limitations in everyday activities. While the disorder may eventually resolve naturally, recovery is frequently gradual and might take several years, emphasizing the need for early identification and treatment in improving the prognosis and lowering the risk of long-term disability.

Some possible complications of an untreated Frozen Shoulder include:

• Long-term or permanent loss of shoulder mobility.
• Disrupts pain, leisure activity, or limits work.
• Impacts the strength of the arm
• Joint deterioration and development of secondary problems, such as compensatory pain in the opposite shoulder, back, and neck, or poor posture
• Increased risk of accidental injuries due to changes in the movement patterns
• Potentially leads to chronic inflammation
• Impose psychological burden like frustration, depression, and anxiety
• 40% of the population may still experience these symptoms for up to 4 years if the condition is not treated.

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