Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by stiffness and pain in the shoulder joint. This condition can develop gradually, often without any prior injury, and significantly limits the range of motion in the shoulder.

It affects approximately 2% of the population, being more common in women than men, and typically occurs between the ages of 40 and 60.

The condition progresses through three stages:

  • Freezing stage: Pain gradually increases and shoulder movement becomes restricted.
  • Frozen stage: Pain may decrease, but stiffness remains.
  • Thawing stage: Shoulder movement slowly returns to normal.

This entire process can take anywhere from several months to over two years.

There are two types of frozen shoulder:

  • Primary (idiopathic)
    Primary frozen shoulder develops spontaneously without any identifiable cause.

  • Secondary
    Secondary frozen shoulder occurs following an injury, surgery, or as a result of another medical condition.

 

The exact cause of frozen shoulder is not fully understood, but it is associated with several risk factors and conditions:

  • Diabetes
  • Thyroid disease
  • Heart disease
  • Parkinson’s disease
  • Shoulder injury or surgery
  • Prolonged immobilisation of the shoulder

The main symptoms of frozen shoulder include:

  • Persistent dull ache in the shoulder
  • Pain radiating towards the elbow or shoulder blade
  • Pain at rest, worsening with movement
  • Night pain that can affect sleep
  • Gradual loss of shoulder movement and stiffness

Anatomy of the Shoulder

The shoulder is a shallow ball and socket joint that allows a wide range of movement. Stability is provided by several structures: the joint capsule, ligaments, and rotator cuff muscles. The joint capsule is a soft tissue envelope that surrounds the shoulder joint and is filled with synovial fluid, which lubricates the joint to facilitate smooth movement. In frozen shoulder, the joint capsule becomes inflamed and thickened, leading to the formation of scar tissue. This excessive scar formation restricts the shoulder’s movement, causing pain and stiffness.

Shoulder Anatomy

Treatment & Surgery Options

Frozen shoulder often improves on its own, although this can take more than two years.

Non-surgical treatments focus on controlling pain and maintaining movement:

  • Pain relief with paracetamol or anti-inflammatories like ibuprofen
  • Steroid injections to reduce inflammation
  • Physiotherapy involving stretching and strength exercises
  • Applying heat before exercising to help loosen the joint

Over 90% of patients experience improvement with these measures.

Surgery is rarely needed for frozen shoulder. However, if stiffness does not improve with non-surgical treatments, two procedures may be performed:

  • Manipulation under anaesthesia: Under general anaesthesia, your surgeon forcibly moves the shoulder to break up the scar tissue to increase the range of motion.
  • Arthroscopic capsular release: A minimally invasive surgery where your surgeon uses small instruments to cut through the thickened joint capsule, increasing the range of motion.

These procedures are generally effective but should not be done during the inflammatory (freezing) stage as they may worsen the condition.

By understanding the causes, symptoms, and treatment options, individuals with frozen shoulder can manage their condition effectively and improve their quality of life.

View Specific Treatment Page

Downloadable info sheets related to Frozen Shoulder

These notes from OrthoSport Victoria are for educational purposes only and are not to be used as medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.

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