Research says that about 4% to 26% of the general population will experience shoulder pain. (1) Ultimately, some would go on to develop Frozen Shoulder. So, what is a frozen shoulder, can we prevent it, and how does it happen?
Answers to all that and more below.
How does frozen shoulder happen?
Frozen Shoulder – also called Adhesive Capsulitis and Periarthritis – is fairly common. In fact, it happens to about 5% of the population. (5)
You see, the shoulder joint is a ball-and-socket joint covered with a joint capsule. This envelopes the joint with synovial fluid to provide lubrication.
With Frozen Shoulder, synovial inflammation damages the lining of the joint capsule. This results in a thick fibrotic band of tissues.
Moreover, synovial fluid also decreases and adhesions develop within the capsule.
This combination results in a tight and painful shoulder joint.
Other tell-tale symptoms include stiffness and progressive limitation of motion of your shoulder.
Types of frozen shoulder
The classifications of Frozen shoulder depend on your history, including:
- Primary (Idiopathic). This refers to the spontaneous onset of shoulder pain with no known origin. Symptoms worsen and progress to stiffness and limitation of function.
- Secondary. This results from other injuries or conditions. Examples include previous surgery, trauma, and systemic disease. The preceding event leads to the development of a painful and stiff shoulder.
Risk factors for developing frozen shoulder
There are several known risk factors that increase the likelihood of frozen shoulder. These include (2):
- Diabetes Mellitus
- Female
- Going through menopause
- First Degree Relative had a previous case of frozen shoulder
- Over 40 years of age
- Positive HLA-B27 antigen
- Previous trauma on shoulder
- Prolonged immobilization of shoulder joint
- Thyroid Disorder
Worth paying attention to is diabetes. The disease increases the chances of developing a frozen shoulder by up 2-4 times. (3)
Learn more: Why is frozen shoulder so common in diabetics?
Diagnosis
Your physician will go through a full physical examination of your upper body. Indications for a frozen shoulder are:
- Dull, aching pain at end ranges of shoulder motion
- Shoulder shrugging during arm movement
- Limited flexion (arm pointing forward)
- Limited abduction (arms pointing sideward)
- Limited external rotation (arms turned outward)
Your doctor may also request imaging tests for a more detailed look inside your shoulder. These include X-rays, MRI, or Arthrography.
Signs and symptoms
Frozen shoulder goes through three stages, each having distinct signs and symptoms. (4)
Each stage may overlap with the other:
- Freezing – characterized as an initial onset of shoulder pain, which is worst at night. There is also a gradual decrease in shoulder range of motion. May last anywhere between 2-9 months.
- Frozen – pain intensity decreases although it may still be present at end ranges. Also, a noticeable progressive loss of shoulder range of motion is evident. May last from 4 – 12 months.
- Thawing – visible improvement of shoulder range of motion. Pain is still experienced at extreme end ranges. May last from 12 – 42 months.
Fun fact: Pain from a frozen shoulder is one of the more common reasons why your shoulders hurt when you wake up.
Prognosis
Frozen shoulder is a self-limiting condition. Meaning, it generally gets better on its own even without any treatment.
But, a wait-and-see approach can be risky and recovery may take longer.
In fact, a 2021 study says that recovery may take up to 2-3 years. Some patients don’t experience full recovery at all. (5)
Hence, the importance of getting treatment to manage symptoms and improve function.
Treatment Options
Several treatment options are available to help make recovery faster (6):
Conservative
Oral Medication
Often prescribed are non-steroidal anti-inflammatory drugs (NSAIDS). This reduces pain and inflammation especially during the early stages of frozen shoulder. Ibuprofen and Paracetamol are examples.
Corticosteroid Injection
Corticosteroids are also anti-inflammatory drugs. A study says they can relieve pain and mobility for up to 2-24 weeks when injected inside the shoulder capsule. (7)
Physical Therapy
PTs manage symptoms with a comprehensive treatment program. This includes, but are not limited to:
- Joint mobilization and stretching to improve shoulder range of motion
- Modalities (ice/heat packs, electrotherapy) for pain relief
- Progressive strengthening program to improve function.
Surgical
Manipulation under Anesthesia
The surgeon moves your arm through ranges of motion while you’re under general anesthesia. This leads to a passive tearing of the fibrotic capsule and relieve tightness.
Although effective, it can also have complications. These include possible arm fractures and nerve injury.
Arthroscopic Capsular Release
This procedure uses a small probe inserted within the shoulder capsule. This helps guide the surgeon in making small incisions to the damaged capsular tissue.
This, in turn, decreases stiffness and pain.
Tips for Preventing Frozen Shoulder
- Adapt to an ergonomically correct workstation.
- Maintain a strong immune system.
- Improve shoulder mobility through daily stretching and range of motion exercises.
- If you have diabetes, take insulin as prescribed.
- Follow a diet for frozen shoulder.
- Follow up with your physician or physical therapist. Do this right after surgery to avoid unnecessary immobilization.
FAQs
Is heat or ice better?
Both ice and heat are effective in reducing pain in a frozen shoulder. The only difference would be when you would be using them.
Ice is generally used during acute cases when swelling is also present. Heat can be applied once the swelling has reduced. This can improve blood flow and stimulate tissue healing.
Is it okay to massage a frozen shoulder?
Massage is a safe alternative to reduce pain and muscle tightness, and improve blood flow within the area. This can be the method of choice of people who have decreased sensation where ice or heat may cause burn.
Learn more: Best massage techniques for frozen shoulder.
How can I sleep comfortably with a frozen shoulder?
Try to avoid laying on your symptomatic shoulder as this may increase compression and pain. When laying on your uninvolved side, place a pillow in between your arms and trunk to provide support. And when laying at your back, placing a pillow under your symptomatic arm will help avoid laying on that side.
For further reading: Why side-sleeping can hurt your shoulders.
Conclusion
Frozen Shoulder is a very bothersome condition to deal with. It limits our ability to do basic tasks such as reaching overhead. It can even affect our sleep patterns.
Keys to preventing frozen shoulder include exercise and maintaining an appropriate sugar level.
Resources:
- Murphy, Richard J, and Andrew J Carr. “Shoulder pain.” BMJ clinical evidence vol. 2010 1107. 22 Jul. 2010 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217726/
- Le, Hai V et al. “Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments.” Shoulder & elbow vol. 9,2 (2017): 75-84. doi:10.1177/1758573216676786
- Inayat, Faisal et al. “Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan.” Cureus vol. 9,8 e1544. 6 Aug. 2017, doi:10.7759/cureus.1544
- Rangan, Amar et al. “Frozen Shoulder.” Shoulder & elbow vol. 7,4 (2015): 299-307. doi:10.1177/1758573215601779
- Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2021 Jul 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/
- Cho, Chul-Hyun et al. “Treatment Strategy for Frozen Shoulder.” Clinics in orthopedic surgery vol. 11,3 (2019): 249-257. doi:10.4055/cios.2019.11.3.249
- Xiao, Ryan C et al. “Corticosteroid Injections for Adhesive Capsulitis: A Review.” Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine vol. 27,3 (2017): 308-320. doi:10.1097/JSM.0000000000000358