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Dr. Nitika Makhija
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Frozen shoulder

Frozen shoulder

Overview

Frozen shoulder is a condition characterized by pain, stiffness and restricted mobility in the shoulder joint. 

 

Frozen shoulder is mostly seen in people between 40 and 60 years old. Women tend to get affected more than men. 

 

The exact cause remains elusive, but inflammation and the formation of adhesions within the joint are contributing factors. Individuals with diabetes, thyroid disorders, rheumatoid arthritis or those recovering from prolonged immobility due to surgery or injury are more susceptible. 

 

Treatment often combines pain relief medications, anti-inflammatory drugs, and physical therapy to improve range of motion. In severe cases, procedures like joint distension or manipulation under anesthesia may be considered. 

Key Facts

Usually seen in
  • Individuals between 40 to 60 years of age
Gender affected
  • Both men and women but more common in women
Body part(s) involved
  • Shoulder
Prevalence
  • Worldwide: 2-5%
Mimicking Conditions
  • Shoulder impingement syndrome
  • Post-stroke shoulder subluxation
  • Referred pain (cervical spine or malignancy, e.g., Pancoast tumor)
Necessary health tests/imaging
  • Medical history and physical examination
  • Imaging tests:  X-rays, MRI, ultrasound
Treatment
  • NSAIDs: Ibuprofen, diclofenac, paracetamol.
  • Corticosteroid injections
  • Hydrodistention
  • Electrical stimulation:  Transcutaneous Electrical Nerve Stimulation (TENS), ultrasound therapy
  • Surgery: Arthroscopic Capsular Release (ACR) surgery, Manipulation Under Anesthesia (MUA)
  • Post-operative rehabilitation
Specialists to consult
  • General physician
  • Orthopedician
  • Physiotherapist
  • Rehabilitation Specialist

Symptoms Of Frozen shoulder 

 

Prominent symptoms of a frozen shoulder include:

  • Pain and enduring stiffness in the shoulder joint

  • A challenge in raising one's arm above the head

  • Difficulty extending the arm across the body or reaching behind the back

 

Frozen shoulder spans out in the following phases:

1. Painful or ‘freezing’ phase

  • Gradual onset of shoulder pain, which worsens over time.

  • Pain is often felt deep in the shoulder and can be particularly intense at night.

  • The shoulder starts to lose range of motion, making daily activities like reaching or dressing challenging.

  • This stage can last anywhere from 6 weeks to 9 months.

 

2. Stiffness or ‘frozen’ phase

  • Pain might lessen during this stage but stiffness becomes more pronounced.

  • The shoulder joint becomes increasingly immobile, and activities that involve lifting the arm become extremely difficult.

  • Using the affected arm for everyday tasks becomes severely limited.

  • This stage might span anywhere from 4 to 12 months.

 

3. Resolution or ‘thawing’ phase

  • The range of motion in the shoulder gradually improves, but it may take several months to years to return to normal.

  • Pain might subside, but some discomfort may still be present during movement.

  • Functional use of the shoulder improves, and daily activities become easier to perform.

  • Full recovery or complete strength typically takes from 5 months to 2 years.

Causes Of Frozen shoulder

 

Frozen shoulder is a complex condition in which the underlying cause or disease is mostly unknown and cannot be pinpointed to any specific reason. It is initiated by inflammation and thickening of the joint capsule.

 

In some cases, frozen shoulder may be associated with the following factors:

 

a. Intrinsic: This type is connected to problems with the tendons around the shoulder joint like tendinitis or tears. It can also be related to issues with calcium deposits in the tendons.

 

b. Extrinsic: This type is caused by factors outside the shoulder joint, such as previous breast surgery on the same side, neck nerve problems, tumors on the chest wall, past stroke, or problems with the bones in the shoulder region.

 

c. Systemic diseases: This type is associated with conditions that affect the whole body, like diabetes, thyroid disorders (hyperthyroidism or hypothyroidism), or problems with the adrenal gland.

Risk Factors For Frozen shoulder

 

  1. Age: Frozen shoulder tends to occur more frequently in individuals between the ages of 40 and 60 years old. 

  2. Gender: Women are more likely to be affected by frozen shoulders than men. Hormonal fluctuations, especially during perimenopause, menopause, and pregnancy, may contribute to this increased occurrence. 
  3. Previous shoulder injury or surgery: Individuals who have experienced previous shoulder injuries or undergone shoulder surgery are at higher risk of developing frozen shoulder.

  4. Immobilization: Any condition or injury that leads to prolonged immobilization of the shoulder joint can increase the likelihood of developing frozen shoulder. This can include conditions like injuries, fractures, or prolonged bed rest.

  5. Systemic diseases: Certain systemic conditions like, thyroid disorders (hyperthyroidism or hypothyroidism), cardiovascular disease, and Parkinson's disease have been associated with an increased risk of frozen shoulder.

  6. Autoimmune conditions: People with autoimmune conditions, such as rheumatoid arthritis, have a higher likelihood of developing frozen shoulder.

  7. Dupuytren's disease: Dupuytren's disease, a condition that causes the thickening and tightening of the connective tissue in the hand is associated with an increased risk of frozen shoulder.
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Diagnosis Of Frozen shoulder

 

Diagnosing a frozen shoulder involves a combination of medical history, physical examination, and possibly imaging tests:

 

1. Medical history: The doctor will begin by discussing your symptoms and medical history. They will ask questions about your shoulder pain, the duration of symptoms, any past injuries or medical conditions, and activities that may have contributed to the onset of the problem.

2. Physical examination: During the physical examination, the healthcare professional will check your shoulder's range of motion, strength, and any specific movements that cause pain or discomfort. They will also look for signs of inflammation, swelling, or muscle atrophy in the affected shoulder.
 

3. Imaging tests: The doctor may advise certain imaging tests to rule out other potential causes of shoulder pain and to confirm the diagnosis. These tests may include:

  • X-rays: X-rays can help identify other issues like arthritis or bone spurs that may be contributing to the symptoms.

  • MRI (Magnetic Resonance Imaging): An MRI can provide detailed images of the shoulder's soft tissues, such as muscles, tendons, and ligaments, to evaluate any potential structural problems.

  • Ultrasound: This imaging technique may also be used to assess the shoulder's soft tissues and detect any abnormalities. 


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Celebs affected

Bhagyashree

Bollywood actress Bhagyashree has shared her experiences with frozen shoulder. She passionately urged her fans not to neglect any signs of pain and address the problem with the right workouts.

Shweta tiwari

Renowned television actress Shweta Tiwari has discussed how her shoulder pain progressed into frozen shoulder. She successfully alleviated the issue by diligently adhering to a routine of exercises and physiotherapy.

Teri Hatcher

In one of her interviews, the renowned American actress revealed, "I've been grappling with a condition known as frozen shoulder, a real ailment that affects women."

Prevention Of Frozen shoulder

 

Here are some simple and effective measures you can adopt to safeguard yourself from the debilitating condition of a frozen shoulder:

 

1. Daily shoulder and back stretch: Devote a few moments each day to gently stretch your shoulder and back muscles. This helps maintain their flexibility and ensures they remain supple and resilient.

 

2. Proper posture and ergonomics: Maintain good posture and ergonomics during daily activities to reduce strain on the shoulder joints. Avoid hunching over or slouching for long periods.

 

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3. Warm-up before workout: Prioritize warming up your shoulder muscles before engaging in physical activities or exercises that require significant shoulder involvement.

 

4. Balanced exercise routine: Avoid overloading the shoulder joint and focus on a well-rounded exercise routine that works on various muscle groups. Include exercises that strengthen the muscles around the shoulder, such as the rotator cuff muscles.

 

5. Avoid traumatic injuries: Take precautions to prevent traumatic injuries to the shoulder, such as wearing appropriate protective gear during sports and other activities.

 

6. Prioritize a healthy lifestyle: Adopt a healthy lifestyle that includes a balanced diet, regular exercise, and adequate rest, as these factors can contribute to overall joint health.

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7. Diabetes management: Diabetes can increase the vulnerability to frozen shoulder, making it crucial to keep blood sugar levels in check to minimize the risk.

Invest in a reliable blood glucose monitor for accurate and convenient tracking of sugar levels.

8. Avoid prolonged immobilization: Try not to keep your shoulder immobile for extended periods, especially after an injury or surgery. It's crucial to follow proper rehabilitation protocols and keep the shoulder joint moving within a pain-free range as soon as possible.

 

9. Listen to your body: If you experience any shoulder pain, stiffness, or limited range of motion, don't ignore it. Seek medical attention early to prevent the condition from worsening.

Doctor To Visit

 

When symptoms of shoulder pain start to become bothersome and it becomes difficult to perform daily activities, or you have stiffness that does not go away, and pain worsens at night when sleeping. It is important to visit a doctor for a timely diagnosis.

 

Specialists who can help in the diagnosis and treatment of the condition include:

  • General physician
  • Orthopedician
  • Physiotherapist 
  • Rehabilitation Specialist  

 

General physicians help diagnose and initiate early intervention for frozen shoulder. They might refer you to an orthopedicians if required.

Orthopedicians specialize in treating frozen shoulder, offering a range of interventions from medications to surgery, focused on restoring shoulder function and alleviating pain.

A physiotherapist designs personalized exercise programs to improve shoulder mobility and strength, reduce pain, and prevent stiffness using modalities like heat and electrical stimulation.

Rehabilitation specialists focus on non-surgical approaches to restore function and mobility of the shoulders.

If you are struggling with a frozen shoulder, connect with our trusted panel of doctors.

Treatment Of Frozen shoulder

 

The treatment of frozen shoulder can be broadly categorized into non-operative methods and operative methods. 

 

Most cases of frozen shoulder can be effectively managed with conservative/ non-operative methods, while operative/surgical methods are reserved for severe cases that do not respond to conservative methods.

 

I. Conservative/Non-Operative methods:


1. Oral pain relief medications: Certain nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation. These, together with physiotherapy are the mainstay of treatment for frozen shoulder. 

Examples include- Ibuprofen, diclofenac, and paracetamol.

2. Corticosteroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation and provide pain relief. However, due to potential negative effects, their usage is restricted.

3. Hydrodistention: This process involves injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. This is occasionally used in conjunction with a steroid injection.

4. Electrical stimulation:  It includes two methods

  • Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a therapy that uses electrical currents to relieve pain and promote muscle relaxation.

  • Ultrasound therapy: Ultrasound can help improve blood flow and promote tissue healing in the affected area.

II. Operative/ surgical methods

Surgery is typically considered a last resort and is only recommended if conservative treatments have not resulted in significant improvement.

1. Arthroscopic Capsular Release (ACR) surgery: During this minimally invasive procedure, a surgeon uses an arthroscope to cut through the tight joint capsule, releasing the adhesions and improving shoulder mobility.

2. Manipulation Under Anesthesia (MUA): In this procedure, the scar tissue and adhesions are broken under anesthesia. It is often performed in conjunction with arthroscopic capsular release. 

Recovery from surgery may take several weeks, and physical therapy is usually prescribed postoperatively to regain full shoulder function.

III. Post-operative rehabilitation

  • Post-operative rehabilitation begins promptly after surgery to prevent stiffness.

  • Includes gentle range of motion exercises, shoulder stretches, and progressive strengthening exercises.

  • Ongoing guidance from a healthcare professional is vital for successful recovery.

  • Heat therapy and manual techniques may be used to relax muscles and increase blood flow.

  • Consistent and supervised physiotherapy aids in the gradual recovery and restoration of shoulder function.

Home-care For Frozen shoulder

 

1. Consume a balanced nutritious diet

Try to include foods that are rich in the following nutrients to augment joint health:

  • Calcium: Dairy products, leafy green vegetables (kale, broccoli), fortified plant-based milk, and calcium-fortified foods like tofu.

  • Vitamin D: Fatty fish (salmon, mackerel), fortified dairy or plant-based milk, egg yolks, and exposure to sunlight (15-20 minutes of sunlight on arms and legs a few times a week).

  • Omega-3 fatty acids: Fatty fish (salmon, sardines), flaxseeds, chia seeds, walnuts, and canola oil.

  • Antioxidants: Incorporate berries, oranges, spinach, and bell peppers into your diet.

  • Protein: Ensure adequate protein from lean meats, poultry, fish, beans, lentils, and quinoa.

  • Magnesium: Include nuts (almonds, cashews), seeds (pumpkin seeds, sunflower seeds), spinach, and whole grains.

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2. Practice proper ergonomic posture: Prioritize maintaining a proper ergonomic posture to reduce strain on your body during daily activities. Avoid heavy lifting to further support musculoskeletal well-being.

 

3. Make sure to get good sleep: Sound and sufficient sleep is the cornerstone of good health and recovery. Make sure to use a supportive mattress and pillow to support your back and shoulders for undisturbed sleep. 

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4. Try hot and cold therapy: Applying heat or cold packs to the affected shoulder can provide temporary relief from pain and stiffness. Warm showers or heating pads may help relax the muscles, while ice packs can reduce inflammation and numb the area.

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5. Try topical preparations: Consider using topical preparations, such as menthol and camphor oil, along with sesame oil on the affected area. They help to offer relief from symptoms and promote joint health. 


6. Consider OTC pain relief: Over-the-counter (OTC) pain-relieving sprays and creams can also be applied to the affected area.

Explore our curated selection of pain relief products

7. Provide joint support: Provide support to weak joints with braces or supports. 

Explore our detailed guide on how to buy the right orthopedic support and braces.

Culinary solutions

1. Turmeric (Haldi): It has anti-inflammatory properties that relieves inflammation and swelling. You can use it orally as turmeric milk or add it to your meals. It can also be applied topically on the shoulder for pain relief.

 

2. Ginger (Adarak): Its anti-inflammatory and antioxidant properties aid in relieving pain, swelling and quick healing. It can be used in various forms like adding it in cooking meals, ginger juice, or you can also apply crushed ginger juice on affected areas.

3. Cinnamon (Dalchini): Cinnamon has anti-inflammatory properties which can help relieve pain. You can add more cinnamon to food or try having crushed cinnamon powder mixed with honey and warm water.

4. Devil's Claw tea: Consume Devil's Claw tea, known for its anti-inflammatory properties. It may contribute to reducing inflammation and easing discomfort. Consume as a tea by steeping 1-2 teaspoons of dried Devil's Claw root in hot water for 10-15 minutes. It is also available as a supplement or herbal tea. 

Discover our selection of Devil's Claw supplements.

Complications Of Frozen shoulder

 

1. Residual pain: After the active phase of the frozen shoulder has resolved, some individuals may experience lingering pain in the affected shoulder. This residual pain can persist even after the range of motion has improved.

 

2. Residual stiffness: While the primary symptom of frozen shoulder is stiffness, even after the condition has resolved, some individuals may still experience some degree of residual stiffness or limitation in shoulder mobility.

 

3. Fracture of the humerus: If a frozen shoulder is treated too forcefully or aggressively, it can lead to rare complications. One complication is a fracture in the upper arm bone (humerus), especially if the bone is already weak due to osteoporosis or other reasons.

 

4. Rupture of the biceps tendon: The biceps tendon is a part of the shoulder joint, and it can tear if too much force is used during a procedure called Manipulation under Anesthesia (MUA), which is sometimes done to improve shoulder movement in frozen shoulder cases. This can cause more pain and difficulty in using the shoulder.

Alternative Therapies For Frozen shoulder


Here are some complementary and alternative therapies that have been explored for frozen shoulder. Make sure to take consent from your healthcare provider before initiating any of these:


1. Yoga and stretching exercises: To improve frozen shoulder, consider practicing yoga poses like 

  • Garudasana
  • Paschim Namaskarasana
  • Ustrasana
  • Dhanurasana
  • Purvottanasana

Ensure proper guidance from a qualified yoga instructor to prevent aggravating the condition.

 

2. Tai Chi: Tai Chi is a low-impact, meditative martial art that emphasizes slow, flowing movements. It can help improve balance, posture, and joint flexibility, including the shoulder.

 

3. Cupping Therapy: Cupping involves placing cups on the skin to create suction, which is believed to promote blood flow and reduce muscle tension. It can be applied to the affected shoulder area.

4. Acupuncture: Acupuncture is a practice involving the insertion of thin needles into specific points on the body to stimulate energy flow, has been associated with pain relief and improved range of motion in some individuals with frozen shoulders.

5. Moxibustion: Moxibustion involves burning dried mugwort (moxa) near specific acupuncture points. The heat generated is believed to stimulate blood flow and energy flow, aiding in pain relief and reducing inflammation.

Living With Frozen shoulder

 

Living with a frozen shoulder can be challenging, as it can significantly impact your quality of life due to limited range of motion and chronic pain. It affects daily living activities (showering, dressing, cycling, swimming, cooking etc.), disrupts sleep, and impacts social and occupational engagement which  may consequently lead to psychological distress.

However, coping with the condition requires a combination of medical treatment, exercises, and lifestyle adjustments. 

Here are some tips to help you live with frozen shoulder and improve your quality of life: 

 

Lifestyle Modifications

Adapt your daily activities to minimize strain on your shoulder. Avoid heavy lifting or repetitive movements that can exacerbate the pain and stiffness.

 

Assistive Devices

Utilize assistive devices like a shoulder sling or brace to support and protect your shoulder joint during activities.

 

Maintain Good Posture

Proper posture can reduce stress on the shoulder joint. Focus on keeping your shoulders back and down, especially when sitting or standing for extended periods.

 

Psychological Support

Living with a chronic condition can be emotionally challenging. Seek support from friends, family, or join support groups to connect with others who share similar experiences. Psychological support can help you cope better with the emotional toll of dealing with frozen shoulder.

 

Be Patient

Frozen shoulder can take time to heal, sometimes up to several months or even years. Be patient and consistent with your treatment and rehabilitation efforts.

 

Stay Active

While certain activities may need to be limited, staying physically active is essential for overall well-being. Engage in low-impact exercises that do not worsen your symptoms, such as walking or swimming.

 

Avoid Activities that Aggravate Symptoms

Identify and avoid movements or activities that cause increased pain or stiffness in your shoulder.

 

Take medication on time

Adhere to your doctor's prescribed medication schedule without fail. For chronic joint pain, consult your doctor before taking any painkillers; avoid self-medication. Regularly visit your doctor, particularly if symptoms worsen or return.

Frequently Asked Questions

References

  1. Frozen Shoulder [Internet]. [cited 2023 Jul 20]. Available from: External Link
  2. Author links open overlay panelKazuya Tamai, AbstractBackgroundPrimary frozen shoulder (FS) is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Investigation of the intra-articular and periarticular pathology would contribute to the treatm. Primary frozen shoulder: Brief review of pathology and imaging abnormalities [Internet]. Elsevier; 2015 [cited 2023 Jul 20]. Available from: External Link
  3. How to release a frozen shoulder [Internet]. 2023 [cited 2023 Jul 20]. Available from: External Link
  4. Frozen Shoulder (capsulitis) risk factors & treatments: HSS [Internet]. [cited 2023 Jul 20]. Available from: External Link
  5. Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: External Link
  6. Frozen shoulder [Internet]. [cited 2023 Jul 20]. Available from: External Link
  7. Catherinejordan. Frozen shoulder syndrome – diagnosis, prevention and treatment [Internet]. 2023 [cited 2023 Jul 20]. Available from: External Link
  8. Management of the frozen shoulder [Internet]. [cited 2023 Jul 20]. Available from: External Link
  9. Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & elbow, 9(2), 75–84. External Link
  10. Gao, M., Cong, H., Li, C., Qin, X., An, H., & Jiang, Z. (2021). Comparison of efficacy and safety of complementary and alternative therapies for scapulohumeral periarthritis: A protocol for Bayesian network meta-analysis. Medicine, 100(18), e25769. External Link
  11. Sun, C., Qi, B., Huang, X., Chen, M., Jin, Z., Zhang, Y., Zhu, L., & Wei, X. (2022). Baduanjin exercise: A potential promising therapy toward osteoporosis. Frontiers in medicine, 9, 935961. External Link
  12. Lyne SA, Goldblatt FM, Shanahan EM. Living with a frozen shoulder – a phenomenological inquiry - BMC musculoskeletal disorders [Internet]. BioMed Central; 2022 [cited 2023 Jul 20]. Available from: External Link
  13. Nagy MT, MacFarlane RJ, Khan Y, Waseem M. The frozen shoulder: Myths and realities [Internet]. [cited 2023 Jul 20]. Available from: External Link
  14. Cohen, C., Tortato, S., Silva, O. B. S., Leal, M. F., Ejnisman, B., & Faloppa, F. (2020). Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences. Revista brasileira de ortopedia, 55(4), 483–489. External Link
  15. CP; PA. Is there a genetic predisposition to frozen shoulder?: A systematic review and meta-analysis [Internet]. U.S. National Library of Medicine; [cited 2023 Jul 20]. Available from: External Link
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