Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint. The symptoms often start gradually, worsen over time, and then resolve, typically within a two to three-year period. In many cases, the exact cause of a frozen shoulder is not known (Robinson et al., 2012)[1]. This article provides a comprehensive overview of frozen shoulder, from its causes and symptoms to its management and prognosis.

Understanding Frozen Shoulder

The shoulder is a ball-and-socket joint with significant range of motion. However, in a frozen shoulder, the joint capsule, the connective tissue surrounding the shoulder joint, thickens and tightens around the joint, restricting its movement (Zuckerman and Rokito, 2011)[2].

Causes and Risk Factors

While the exact causes are not definitively known, several factors can increase the risk of developing a frozen shoulder:

1. Age and Sex: It commonly affects individuals between the ages of 40 and 60 and is more prevalent in women (Neviaser et al., 2011)[3].
2. Immobilization: Prolonged immobility due to a rotator cuff injury, a broken arm, stroke, or recovery from surgery can increase the risk (Robinson et al., 2012)[1].
3. Systemic Diseases: Conditions like diabetes, overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), cardiovascular disease, tuberculosis, and Parkinson’s disease are linked with a higher risk of frozen shoulder (Zuckerman and Rokito, 2011)[2].

Symptoms and Diagnosis

The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move the shoulder. The condition typically progresses slowly in three stages:

1. Freezing stage: The shoulder starts to hurt when moved, and the pain usually worsens at night. This stage can last from six weeks to nine months (Robinson et al., 2012)[1].
2. Frozen stage: The pain might begin to diminish, but the shoulder becomes stiffer and using it becomes more difficult. This stage can last from four to six months (Zuckerman and Rokito, 2011)[2].
3. Thawing stage: The range of motion begins to improve. This stage can last from six months to two years (Neviaser et al., 2011)[3].

A healthcare professional can usually diagnose frozen shoulder based on the patient’s symptoms and a physical examination. Imaging tests like X-rays or MRI can rule out other issues like arthritis or torn rotator cuff (Robinson et al., 2012)[1].

Treatment and Management

The primary treatment goals for frozen shoulder are to alleviate pain and restore normal range of motion. The following strategies may be employed:

1. Pain relievers: Over-the-counter pain relievers can help reduce pain and inflammation (Robinson et al., 2012)[1].
2. Physical Therapy: Regular physical therapy is crucial in restoring mobility. The therapist may use a combination of exercises and manual therapy techniques to increase the range of motion (Zuckerman and Rokito, 2011)[2].
3. Steroid Injections: Corticosteroid injections into the shoulder joint can reduce inflammation and allow more comfortable physical therapy (Neviaser et al., 2011)[3].
4. Joint Distension: In this procedure, sterile water is injected into the joint capsule to stretch it and make movement easier (

Robinson et al., 2012)[1].

5. Shoulder Manipulation: This involves moving the shoulder joint in different directions under general anesthesia (Zuckerman and Rokito, 2011)[2].
6. Surgery: If other treatments are unsuccessful, surgery to remove scar tissue and adhesions inside the joint may be considered (Neviaser et al., 2011)[3].

Living with Frozen Shoulder

Living with frozen shoulder can be challenging due to the pain and limitations in daily activities. However, patient education about the condition, appropriate pain management, and a regular exercise program can help individuals navigate through this condition and recover their shoulder function over time (Lorbach et al., 2010)[4].

Conclusion

Frozen shoulder, while debilitating in its course, is generally self-limiting, with most individuals regaining shoulder function over time. Early recognition and proactive management can significantly improve the prognosis and limit the impact on a person’s quality of life.

References

[1] Robinson, C.M., et al. (2012). Frozen shoulder. Journal of Bone & Joint Surgery.

[2] Zuckerman, J.D., and Rokito, A. (2011). Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery.

[3] Neviaser, A., et al. (2011). Adhesive capsulitis: a review of current treatment. The American Journal of Sports Medicine.

[4] Lorbach, O., et al. (2010). Long-term results after arthroscopic capsular release for idiopathic adhesive capsulitis. Journal of Shoulder and Elbow Surgery.