The term “frozen shoulder” is used to describe a condition characterised by pain and gradual loss of range of motion of shoulder. It occurs in up to 5% of the population and is more common in females. Frozen shoulder affects patients between ages of 40 and 60 years and the non-dominant shoulder is more commonly affected. Up to a third of patients who have a frozen shoulder will develop the same condition in the opposite shoulder.
Pain and stiffness in frozen shoulder is due to inflammation and progressive fibrosis (or scarring) of the capsule of the shoulder joint.
This disorder can be subdivided into primary or secondary frozen shoulder.
Primary Frozen Shoulder
This is a frozen shoulder condition which develops in the absence of any other shoulder condition. There is, however, an association with diabetes and thyroid disease. This is more common than the secondary frozen shoulder.
Secondary Frozen Shoulder
The frozen shoulder progresses through four stages before it starts to improve.
Gradual onset of pain typically referred to the middle of the upper arm. Aching pain is experienced at rest and sharp pain on movement. Patient is unable to sleep on the affected side. This stage lasts less than three months.
“Freezing” stage characterised by increasing pain, especially at night, together with gradual limitation of shoulder motion.
“Frozen” stage where the predominant complaint is stiffness and pain is diminished. Symptoms have been present between 9 to 15 months at this point.
“Thawing” stage where pain is a minimal and gradual improvement is seen in the range of motion.
Treatment for Frozen Shoulder
Before treatment can be instituted, the diagnosis has to be confirmed and secondary frozen shoulder has to be excluded. This involves a history suggestive of the disorder with a physical examination by a healthcare professional to exclude other causes of shoulder pain and stiffness.
The physical examination may also be able to pick up causes of secondary frozen shoulder. Finally X-ray images, and in cases where other associated condition are suspected, an ultrasound scan or MRI scan may be obtained.
The treatment of a frozen shoulder involves several possible modalities.
This is the mainstay of treatment. Mobilisation exercises within the limits of pain improve symptoms and function while aggressive stretching is associated with a poorer outcome. The exercises recommended are dependent on the stage of the condition. In the later stages, strengthening exercises are also incorporated.
Oral Anti-inflammatory Medication
Because of the inflammation process involved in this disorder, this class of medication is useful to alleviate the pain component of symptoms and is routinely given.
Manipulation Under Anaesthesia
This procedure also known as MUA. In this procedure, you will be under general anaesthesia while the orthopaedic surgeon tries to move your shoulder to the full range of motion.
By doing this, the scar tissue around the shoulder capsule will break up and release your shoulder capsule. This procedure has a high success rate and many patients has high satisfaction with the result. The advantages of MUA is that it only requires half an hour’s time and there is no cut or wound to your skin.
Surgery is an alternative for the patient who has failed non-operative measures. As a guideline, physiotherapy should be instituted for at least four to six months before it can be concluded that the patient has failed this modality of treatment. Surgery involved is an arthroscopic (keyhole surgery) release of the shoulder capsule.
Dos and Don’ts for Frozen Shoulder
- Seek medical opinion even if you are sure you have a frozen shoulder as a secondary frozen shoulder possibility needs to be excluded. The outcome of a secondary frozen shoulder, if left neglected, can be quite different from that of a primary frozen shoulder.
- Ignore a stiff and painful shoulder as appropriate early intervention results in a shorter duration of discomfort and inconvenience.
- Aggressively stretch a stiff shoulder as it can result in worsening of the frozen shoulder.
Let our orthopaedic surgeon advise you personally on treatments to frozen shoulder.