How to Treat a Frozen Shoulder?

We often come across this very common phrase of “giving the cold shoulder”. The phrase implies someone deliberately ignoring the other by not moving in their direction or by snubbing them by showing their back. The origin of the phrase lies in a medical condition called adhesive capsulitis, popularly called the frozen shoulder. 

This is a very common condition and cases of frozen shoulders spike up, especially around winter. This is also a very common sports injury, especially among people around the age of 40 years. This condition is primarily characterised by stiffness in the joints and pain when trying to mobilise the pain. But what leads to a frozen shoulder? What are its symptoms? How can you get rid of it? To get answers to all possible questions w.r.t. Frozen shoulder, read on…

What is a Frozen Shoulder?

Medically referred to as adhesive capsulitis (AC), a frozen shoulder is when your shoulder develops stiffness and reduces the mobility of your shoulder joints. It hurts to move the shoulder joint. Over a period ranging between 1 to 3 years, the symptoms get better and the condition heals completely.

This condition develops when the shoulder remains in one position for a long time. It is often seen developing post-surgery trauma injuries caused on the arm. It can be treated through physiotherapy exercises, corticosteroid medication, injected pain medication and in extreme cases arthroscopic surgery. The main purpose is to release the stiffness in the joint.

Usually, this condition is found more in women than men. It does not recur in the same shoulder, however, one can have a recurring case if treatment is not done properly. The pain might move from one shoulder to another in some circumstances.

You Can Also Read: Shoulder osteoarthritis – symptoms, causes & treatment 

What are the Symptoms of Frozen Shoulders?

Let us first understand how a normal shoulder works. Our upper arm, collar bone, and shoulder blade, together with tendons and muscles form the shoulder capsule. Synovial fluid in this capsule lubricates the joints for easier movement.

Now for a person with a frozen shoulder, this capsule thickens and becomes stiff. These tissues develop adhesions and the synovial fluid is lowered. Finally, this leads to a stiff shoulder capsule and a frozen shoulder.

While the above is the mechanism of a frozen shoulder, there are no clear-cut symptoms of frozen shoulders. However, one can understand that they are developing the condition by being aware of the stages of a frozen shoulder.

What are the Stages of a Frozen Shoulder?

Typically, a frozen shoulder develops gradually, in three distinct stages.

• Freezing Stage:

In this stage, any slightest motion or movement of the shoulder and shoulder joint causes pain and restricts mobility. This stage builds over time with more and more restricted movements and lasts between 2 to 9 months without treatment.

• Frozen Stage:

At this stage, the pain might be lesser since the body has developed a pain threshold over time. However, the shoulder stiffness grows severe making mobility far more difficult. This stage, if not treated, lasts between 4 to 6 months. For those who experience more pain, the condition worsens at night, often disrupting sleep.

• Thawing Stage:

Post-treatment at this stage, your shoulder’s mobility starts improving. This stage lasts from 5 to 24 months, till the normal range of motion in the shoulders is restored.

You Can Also Read: Shoulder Arthritis – All You Need to Know

What are the Causes of Frozen Shoulders?

The primary cause of a frozen shoulder is stiffness of the shoulder. As explained earlier, the shoulder capsule includes connective tissue lubricated by the Synovial fluid. When the capsule thickens, lubrication depletes and tissues tighten, the frozen shoulder occurs restricting shoulder movement.

The above-mentioned series of events can be linked to:

• Keeping the arm in the same state
• Impact of surgery performed on the arm.
• Congenital causes
• Diabetes and thyroid imbalance.
• Cardiovascular disease
• The onset of Parkinson’s disease.
• Trauma or stress-induced injury.

Based on these causes we can profile the risk factors associated with this disease.

What are the Risk Factors Associated With a Frozen Shoulder?

The people who are at a greater risk of developing a frozen shoulder can be profiled under the following categories:

• Age and gender: Those above 40 to 65 years of age, especially women are more likely to get a frozen shoulder.
• Restricted mobility: Those who have restricted movements are more susceptible to getting a frozen shoulder. This can be due to pre-existing injuries like Rotator cuff injury and a broken arm and its recovery. Apart from this people who have suffered a stroke can also develop a frozen shoulder.
• Diseases: People suffering from diseases like thyroid imbalance, Parkinson’s disease and heart disease can also have a frozen shoulder. Diabetes is also linked to frozen shoulders. This is because uncontrolled blood sugar levels alter collagen levels in the connective tissue of the shoulder joint. This makes collagen, which gives flexibility to joints, sticky. Therefore restricting mobility and causing stiffness.
• Congenital reasons: Based on recent research findings, a set of genes has been identified that in a person makes them more susceptible to developing adhesive capsulitis. Carriers of these genes have almost 6 times more risk of developing a frozen shoulder.

What is the Treatment for Frozen Shoulders?

Your orthopaedic will focus on your pain relief and might suggest a combination of anti-inflammatories or steroid injections with physical therapy to restore shoulder motion.

Shoulder manipulation can also be performed under general anaesthetic to release the stiffness. Another way to release a stiff shoulder is via Hydrodilatation. In this case, along with steroids, sterile water is injected into the joint capsule to stretch the tissue and restore the mobility of the joints.

Apart from medication, a physiotherapist will suggest the following exercises for each of the three stages of a frozen shoulder:

• External rotation (Passive Stretch):

Stage: Freezing

Difficulty: Medium

Procedure: Stand in a doorway. Bend the arm of your affected shoulder 90 degrees and hold one of the sides of the door (as shown in the first image). Now keep your hand in place (as shown in the second image) and rotate your body. Hold the pose for 30 seconds. Relax. Repeat.

• Forward flexion, (Supine position):

Stage: Frozen

Difficulty: Medium

Procedure: Lie on your back with your legs stretched out. Use the arm of your unaffected shoulder to lift your frozen shoulder’s arm overhead. Keep extending the arm till you feel a gentle stretch. Hold for 15 seconds. Relax and slowly return to the starting position. Take a few relaxing breaths and repeat.

• Crossover arm stretch:

Stage: Thawing

Difficulty: Medium

Procedure: Carefully pull an arm across the chest and bring your shoulder under your chin as much as possible. Hold the pose for 30 seconds by breathing in and out. Relax and return to the original pose. Take another breath and repeat.

These stretches will not only help you with a frozen shoulder but also help you prevent any pain or stiffness in your shoulders when you practise them regularly.

In case none of the above gives any respite from the pain, surgery is the ultimate treatment. Here the problem area is approached using arthroscopy, and the scar tissue is removed to eliminate stiffness and relieve the pain completely. However, this is resorted to in rare cases.

How to Prevent a Frozen Shoulder?

Essentially the frozen shoulder is a type of inflammation which makes everyday tasks tedious. The longer it is left untreated the slower the progress w.r.t. the pain. While we cannot confirm whether you will get a frozen shoulder or not, we can take the following preventive measures:

• Maintain stable blood sugar levels.
• Exercise and stretch your shoulders regularly.
• Strengthen your shoulder and arms with the help of physiotherapy.
• Avoid wearing a shoulder sling or keeping your arm in one stance for too long.

Apart from this, it is always advisable we don’t ignore our body’s cry for help. If you experience any prolonged discomfort, do reach out to the Department of Orthopaedics at the CK Birla Hospital. Our award-winning team of seasoned professionals have a proven track record of handling a diverse variety of orthopaedic conditions with precision and care. To book a consultation simply walk in or call +91 124 4570112

FAQ’s:

How Long Do the Stages of Frozen Shoulders Last?

• Freezing Stage: This stage builds over time with restricted shoulder movements and lasts between 2 to 9 months.
• Frozen Stage: This stage, if not treated, lasts between 4 to 6 months. The condition tends to worsen at night, often disrupting sleep.
• Thawing Stage: This stage lasts from 5 to 24 months, till the normal range of motion in the shoulders is restored.

What Are the 3 Stages of a Frozen Shoulder?

• Freezing stage: The slightest motion or movement of the shoulder causes pain and restricts mobility.
• Frozen stage: The shoulder stiffness grows severe making mobility far more difficult.
• Thawing stage: Post-treatment your shoulder’s mobility starts improving. Gradually the shoulder mobility returns.

How to Cure Frozen Shoulders Quickly?

Frozen shoulders often take a while to fully recover. The best route is physiotherapy where we perform a few exercises regularly in different stages of the frozen shoulder. Another cause of frozen shoulder is thyroid and diabetes, which can be controlled through lifestyle changes. For all other treatment options, complete recovery takes up to a full year.

Do’s and Don’ts for Frozen Shoulders

• Maintain stable blood sugar levels.
• Exercise and stretch your shoulders regularly.
• Strengthen your shoulder and arms with the help of physiotherapy.
• Avoid wearing a shoulder sling or keeping your arm in one stance for too long.
• Avoid lifting heavy things frequently.