Frozen Shoulder: Symptoms, Causes, Stages, Treatment & Test
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If a person is experiencing limited shoulder movement due to stiffness and inflammation, they may be suffering from a frozen shoulder. A frozen shoulder occurs when the shoulder joint capsule becomes thick and stiff.
The stiffness in the shoulder caused by this condition can last up to months or even years. Treatment options like frozen shoulder exercises and painkillers can help manage the condition.
Continue reading to learn more about frozen shoulder, its stages, symptoms, causes, risk factors, diagnosis, prevention, and treatment.
Disease Name | Frozen Shoulder |
Alternative Name | Adhesive Capsulitis |
Symptoms | Pain and stiffness in the shoulder, Difficulty in shoulder movement |
Causes |
Shoulder immobilisation after an injury or surgery, Conditions that lead to inflammation of the muscles and tendons, Old age, Systematic diseases (such as Diabetes, Cardiovascular diseases, etc.) |
Diagnosis | Physical examination, Imaging tests |
Treated By | Orthopaedist |
Treatment Options | Home remedies, Anti-inflammatory drugs, Steroid injections, Physical therapy, Alternative medicine, Shoulder manipulation, Shoulder arthroscopy |
What is a Frozen Shoulder?
A frozen shoulder (medical term: adhesive capsulitis) is a painful condition that affects the shoulder joint. It involves pain and stiffness in the shoulder joint leading to limited movement.
The shoulder is a ball-and-socket joint comprising three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the collarbone (clavicle).
- The humerus head fits into the shallow socket of the scapula.
- Strong connective tissue, known as the shoulder joint capsule, surrounds the joint.
- Synovial fluid lubricates the shoulder joint and capsule to help the shoulder move easily.
Frozen Shoulders Types
Frozen shoulder, depending on its causes, can be of the following two types:
- Primary adhesive capsulitis: This condition may affect both shoulders and remain resistant to most forms of treatment. The cause of primary adhesive capsulitis is not known. It may result from changes in the immune system or hormonal imbalances.
- Secondary adhesive capsulitis: This type of frozen shoulder is acquired and develops from a known cause, such as stiffness after a prolonged period of immobility, shoulder injury, or surgery.
Frozen Shoulders Stages
Most people with a frozen shoulder experience worsening pain and a loss of mobility. The pain and immobility can be divided into the 4 stages of a frozen shoulder. A physical therapist can help determine what stage a person is in. The 4 stages of a frozen shoulder include:
- Pre-freezing: The patient may have had symptoms for one to three months but find it difficult to identify the problem as a frozen shoulder.
- Freezing: The symptoms last from six weeks to nine months, with a progressive loss of shoulder movement.
- Frozen: The stage lasts from two to six months, during which the shoulder remains stiff, and it becomes difficult to perform daily activities, such as washing hair, reaching for a seat belt, etc.
- Thawing: This recovery stage can last from six months to two years. The shoulder's ability to move begins to improve.
Frozen Shoulder Symptoms
The primary frozen shoulder symptoms include pain (a dull ache) and stiffness in the shoulder muscles at the top of the arm, making it difficult or impossible to move the shoulder. The frozen shoulder symptoms usually vary among the 4 stages of a frozen shoulder.
Pre-freezing Stage
- Pain even while not using the shoulder
- Increased sharp pain during shoulder movement
- Loss of motion during external rotation, raising the arm or reaching behind the back
- Persistent pain day and night
Freezing Stage
- Stiffness in the shoulder
- Pain in the shoulder with movement
- Increasing pain that worsens at night
- Increased inability to move the shoulder
Frozen Stage
- Pain may reduce, but the stiffness persists
- More difficulty in moving the shoulder
Thawing Stage
- Pain reduces
- The ability to move the shoulder improves
- Normal strength and range of motion return
Frozen Shoulder Causes and Risk Factors
Frozen shoulder causes are unknown. However, a frozen shoulder is most often caused by the inflammation of the tissues (shoulder capsule) surrounding the shoulder joint. Some probable causes of the condition include
- Shoulder immobilisation after an injury or surgery
- Conditions that lead to inflammation of the muscles and tendons (such as bursitis or rotator cuff tendonitis)
Some groups are more at risk of developing this frozen shoulder. Common risk factors that increase the chances of getting a frozen shoulder include:
- Age: Adults, commonly between 40 to 60 years old, are more likely to have a frozen shoulder.
- Gender: The condition is more common in women than men.
- Shoulder injury: Restriction of shoulder movement due to an injury or surgery of the shoulder can increase the risk of a frozen shoulder. Examples of these injuries include rotator cuff tears and fractures of the collarbone, shoulder blade, or upper arm.
- Systemic diseases: Certain systemic diseases that affect the entire body can increase the risk of developing a frozen shoulder. These diseases include
- Diabetes
- Hyperthyroidism (overactive thyroid)
- Hypothyroidism (underactive thyroid)
- Stroke
- Cardiovascular disease
- Parkinson's disease
Prevention of Frozen Shoulder
A frozen shoulder can be prevented only when it follows an injury that makes shoulder mobility difficult. The chance of developing the condition can be prevented or reduced by following tips:
- Maintaining a good posture: Good posture can help keep the shoulder joint in proper alignment and reduce the risk of injury.
- Keep moving: Regular exercise and range-of-motion exercises can help prevent a frozen shoulder by keeping the joint flexible.
- Avoid injury: Avoid shoulder injuries and immobilisation by wearing proper protective gear when playing sports or other physical activities.
- Manage underlying conditions: If a person has a medical condition that increases the risk of a frozen shoulder, he/she should work with the doctor to manage it effectively.
- Maintain a healthy weight: Being overweight can put extra strain on the shoulder, so maintaining a healthy weight can help prevent a frozen shoulder.
- Avoid overuse: Repetitive motions and overuse of the shoulder can increase the risk of a frozen shoulder, so be mindful of excessive use.
- Get physical therapy after injury or surgery: If the person has had an injury or surgery that has immobilised the shoulder, he/she should start physical therapy as soon as possible to prevent a frozen shoulder from developing.
- Stretch and strengthen shoulder muscles: Stretching and strengthening the shoulder muscles can help maintain flexibility and stability, reducing the risk of a frozen shoulder.
If an individual is at risk of developing a frozen shoulder, it's important to discuss preventive measures with the doctor. They can help determine the best approach for individual needs.
How is a Frozen Shoulder diagnosed?
To diagnose a frozen shoulder, the doctor will first discuss the symptoms and review the patient's medical history. Frozen shoulder tests for the diagnosis include
- Physical exam of the arms and shoulders: During a physical exam, the doctor will evaluate pain and compare the active and passive range of motion.
The active range of motion is achieved when the patient moves their shoulder. The passive range of motion is achieved when the doctor moves the patient's shoulder in all directions.
Patients with a frozen shoulder have a limited range of active and passive motion. - Imaging tests: Doctors can usually diagnose a frozen shoulder with signs and symptoms alone. However, they may perform imaging tests such as a shoulder X-ray to help rule out conditions like arthritis.
The doctor may also conduct advanced imaging tests, like Magnetic Resonance Imaging (MRI) and ultrasound, to look for problems such as rotator cuff tears.
How to Prepare for a Doctor’s Consultation?
If a person experiences frozen shoulder symptoms, they might first consult their primary care provider. Sometimes, they may be referred to a doctor specialising in muscles and bones (physiatrist or orthopaedist).
While preparing for the doctor consultation, here are some things that the patient can do:
- Take a prior appointment.
- Note the symptoms and when they began.
- Write down the medical history and family history.
- Enlist all the medications and supplements they take.
- The doctor may ask you some questions. Here is a list of questions that the patient can expect from the doctor during the appointment:
- When did you first notice the symptoms?
- Does anything worsen the symptoms?
- Have you ever injured your shoulder? If yes, how?
- Do you have diabetes or other medical conditions?
- Have you had any recent surgeries on the arm or shoulder?
- Did you have to keep your shoulder still because of an injury or surgery recently?
- Make a list of all the questions for the healthcare provider. Here are some of the questions that the patient can ask the doctor during the appointment:
- What is the cause of my symptoms?
- How can I prevent progression?
- Are there any risks involved?
- What are the treatment options?
- Which one do you suggest?
- Will I need surgery?
- Can it be managed without surgery?
- What is the recovery time?
Frozen Shoulder Treatment
The two main goals of frozen shoulder treatment are to control shoulder pain and increase the range of motion in the shoulder. Treatment usually involves pain relief methods initially.
The doctor may recommend therapy and surgery to regain motion if the problem persists. The treatment options for a frozen shoulder include:
Frozen Shoulder Treatment without surgery
Below are some of the non-surgical treatment methods for a frozen shoulder.
- Home Remedies for frozen shoulder: Home remedies are the first line of treatment that can help alleviate the symptoms of a frozen shoulder. Some of the home remedies include
- Hot and Cold Compress: These can help reduce pain and swelling. Alternating between hot and cold compresses is the most effective way to use this treatment method.
- Massage: Massaging the affected area can help improve circulation and reduce pain and stiffness.
- Medications
- Pain Relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil), aspirin, and acetaminophen (Tylenol, Panadol) can help relieve pain and inflammation in the shoulder.
- Steroid Injections: To manage more severe pain and swelling, the doctor may suggest injecting a corticosteroid, such as cortisone, directly into the shoulder joint.
- Physical Therapy
A physical therapist will teach stretching and range of motion exercises to help recover the shoulder movement. The following are the common frozen shoulder exercises taught by a physical therapist:- External Rotation: The patient would need to stand in the doorway and bend their affected arm's elbow to 90 degrees to reach the doorpost.
Keeping the arm in place, they must rotate their body and hold the position for 30 seconds. They will be asked to relax and repeat. - Forward Flexion: The patient will be asked to lie on their back with their legs straight. They must use their unaffected arm to lift the affected arm overhead until they feel a gentle stretch.
After holding for 15 seconds, the patient will begin lowering the arm to start position. They will be asked to relax and repeat. - Crossover Arm Stretch: The patient must gently pull the affected arm across the chest just below the chin without causing pain. They will be asked to hold the position for 30 seconds, relax, and repeat.
- External Rotation: The patient would need to stand in the doorway and bend their affected arm's elbow to 90 degrees to reach the doorpost.
- Alternative Medicine
- Acupuncture: During the procedure, the doctor inserts hair-thin, flexible needles in the skin at certain trigger points for 15 to 40 minutes.
Acupuncture is a natural frozen shoulder treatment that helps improve blood flow to the area, reduce pain and inflammation, and increase the range of motion. - Transcutaneous Electrical Nerve Stimulation (TENS): It is a nerve stimulation therapy that administers low-voltage electrical currents to key points on a path followed by a nerve. The method helps provide pain relief.
- Acupuncture: During the procedure, the doctor inserts hair-thin, flexible needles in the skin at certain trigger points for 15 to 40 minutes.
Frozen Shoulder Treatment with Surgery
If the treatments mentioned above do not relieve shoulder pain and stiffness even after a year, the doctor may suggest the following procedures:
- Shoulder Manipulation under Anaesthesia: During this procedure, the doctor administers general anaesthesia to put the patient to sleep and feel no pain.
The doctor will force movement of the affected shoulder, causing the joint capsule to stretch and loosen the tightened tissue. The procedure helps in improving the range of motion. - Shoulder Arthroscopy: The doctor inserts small pencil-sized tools through tiny incisions in the shoulder during this surgery. They use these tools to cut through the tight parts of the joint capsule. The surgery is often combined with manipulation under anaesthesia to get better results.
Surgery Name | Surgery Cost |
Manipulation under Anaesthesia | ₹ 50,000 to ₹ 70,000 |
Shoulder Arthroscopy | ₹ 45,000 to ₹ 2,00,000 |
Please Note: The selection of the treatment approach is based on the patient's condition, the stage of the frozen shoulder, and the doctor's opinion.
Risks and Complications of Frozen Shoulder
A frozen shoulder can last a year to three years, causing several problems. If left untreated, a frozen shoulder may result in the following complications:
- Persist pain
- Loss of mobility
- Reduced range of motion
- Muscle trouble that can worsen over time
- Complete immobilisation
- The full-range motion may never return
When to See a Doctor?
Patients should visit their healthcare professional when they experience frozen shoulder symptoms:
- Pain
- Stiffness
- Difficulty sleeping
- Decreased ability to perform everyday activities
- Decreased strength
Diet for Frozen Shoulder
Since inflammation is the primary factor in frozen shoulders, patients should eat foods that help reduce it. While there is no proven dietary option to prevent the onset of a frozen shoulder, an anti-inflammatory diet may help with pain relief and speed up recovery in some patients. Furthermore, it might help to limit the intake of sugar, simple carbohydrates, and saturated fat.
Foods to Include in Frozen Shoulder Diet
- Fruits with anti-inflammatory properties (berries, pineapple, red grapes, etc.)
- Vegetables with antioxidants (broccoli, cabbage, cauliflower, etc.)
- Oily fish (high levels of Omega-3 fatty acids)
- Nuts and seeds
- Spices like turmeric and ginger (have anti-inflammatory properties)
- Extra-virgin olive oil (contains a chemical oleocanthal with effects similar to ibuprofen)
Takeaway
Frozen shoulder is a condition that may cause symptoms such as pain, stiffness, and immobility of the shoulder. While the exact cause of a frozen shoulder is unknown, it is more common in women between 40 and 60.
A frozen shoulder goes through phases before you get completely relieved of your pain and lack of motion. There are several treatment options for the condition, although they may take time to show complete results.
If you are experiencing persistent frozen shoulder symptoms, consult an expert at HexaHealth for an early diagnosis TODAY! Our team will help you manage pain and inflammation with simple methods like medications, physical therapy, and home remedies. If the pain persists, we will guide you through the surgical options and help you connect with the best surgeons near your preferred location.
FAQs for Frozen Shoulder
What is a frozen shoulder?
A frozen shoulder is a condition that affects the shoulder joint, causing pain and stiffness in the shoulder. The condition, also known as adhesive capsulitis, limits the range of motion in the shoulder.
When a person feels pain in the shoulder, they are less likely to use it. As a result, the shoulder becomes "frozen" in its position.
What are the frozen shoulder causes?
What is the fastest way to get rid of a frozen shoulder?
What are the frozen shoulder symptoms?
What are the first signs of a frozen shoulder?
What happens if you don't fix your frozen shoulder?
Does a frozen shoulder show up on MRI?
What are the 4 stages of a frozen shoulder?
The 4 stages of a frozen shoulder include:
- Pre-freezing: Symptoms experienced for one to three months, but difficult to identify the problem
- Freezing: Symptoms last for six weeks to nine months with a loss of shoulder movement
- Frozen: Symptoms last for two to six months, during which the pain reduces, but stiffness persists, making it difficult to perform daily activities.
- Thawing: Recovery stage that lasts from six months to two years
What are the frozen shoulder tests?
A frozen shoulder is usually diagnosed with signs and symptoms alone. However, the doctor may also perform a physical exam of the arm and shoulder to evaluate their range of motion.
Frozen shoulder tests also include imaging tests such as X-ray, MRI, and ultrasound, to rule out other problems, like arthritis or a rotator cuff tear, that may result in a frozen shoulder.
Is a frozen shoulder related to arthritis?
Frozen shoulder is often used interchangeably with arthritis. However, the two conditions are completely different and unrelated. A frozen shoulder affects the shoulder joint and causes stiffness and immobility of the shoulder.
On the other hand, arthritis is inflammation that causes pain, but the patient can still move the shoulder.
What foods should you avoid with a frozen shoulder?
While there is no proven dietary regime for a frozen shoulder, avoiding certain foods can help control inflammation. Foods one must avoid with a frozen shoulder include
- Drinks like caffeine and alcohol (cause stiffness)
- Sugar (reduces elasticity in soft tissues and blood vessels, making them susceptible to injury)
- Simple carbohydrates, trans fats and saturated fats from meat and dairy (they are inflammatory)
Could a frozen shoulder be from a stroke?
Yes, a frozen shoulder can result from a stroke. It may be one of the major causes of shoulder pain after a stroke. A stroke can cause weakness or paralysis of one or more muscles in the arm or shoulder, causing tightness of the muscles.
The tightness in the muscles may lead to shoulder stiffness. As a result, the patient may not move the arm for a prolonged period and develop a frozen shoulder.
What can be misdiagnosed as a frozen shoulder?
Healthcare providers often misdiagnose a frozen shoulder as bursitis. This happens because frozen shoulders and bursitis patients experience similar symptoms, such as night pain and reduced shoulder mobility.
Besides bursitis, a frozen shoulder can also be misdiagnosed as a rotator cuff tear. While both conditions concern shoulder movements, they are different with different outcomes.
Who is prone to frozen shoulder?
Women between 40 and 60 are more prone to developing a frozen shoulder. Other factors that increase the risk of having frozen shoulders include restricting shoulder movement due to an injury or surgery or certain systemic diseases such as:
- Diabetes
- Hyperthyroidism (overactive thyroid)
- Hypothyroidism (underactive thyroid)
- Stroke
- Cardiovascular disease
- Parkinson's disease
Can a frozen shoulder lead to paralysis?
Is heat good for a frozen shoulder?
The heat helps increase blood flow and relieve pain. It may be good for a frozen shoulder to ease the pain. However, heat increases swelling and inflammation, so it should not be used on an inflamed frozen shoulder or an acute injury.
For swelling and inflammation, cold compresses are the best option. Combining cold and heat is the most effective way for immediate pain relief and long-term healing.
Does a frozen shoulder cause pain down the arm?
What aggravates a frozen shoulder?
How to cure a frozen shoulder quickly?
While most frozen shoulders improve on their own within 12 to 18 months, it may take about one to three years for complete recovery. Some quick methods that can help relieve pain and stiffness include hot and cold compresses, NSAIDs like ibuprofen and acetaminophen, and frozen shoulder exercises like external rotation and crossover arm stretch.
If the pain is severe and persistent, the patient may benefit from corticosteroids injected directly into the shoulder joint.
How to sleep with a frozen shoulder?
People with frozen shoulders are prone to poor-quality sleep, especially during the first two stages (pre-freezing and freezing). Getting adequate sleep is critical to promote healing and reduce inflammation.
To sleep comfortably, patients can put a pillow under their affected arm with their hands resting on their stomachs. If a person sleeps on their side, they should sleep on their unaffected shoulder and place the affected arm on a pillow across the chest.
What are the myths versus facts about frozen shoulder?
- Myth: Frozen shoulders always occur due to no apparent cause.
Fact: There can be certain situations where a frozen shoulder develops for no specific reason. However, it usually occurs after the inactivity of the shoulder from an injury or surgery. - Myth: A frozen shoulder occurs and disappears at any time.
Fact: Yes, a frozen shoulder can occur at any time, with or without reason. However, it always needs treatment to disappear. - Myth: Steroid injections can cure a frozen shoulder.
Fact: False! Steroid injections do not cure the frozen shoulder. They are only used to get relief from frozen shoulder symptoms.
Updated on : 4 February 2023
Reviewer
Dr. Aman Priya Khanna
MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES
12 Years Experience
Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More
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With 3 years of full-time experience as an SEO content writer, she has honed her skills to deliver captivating and persuasive writing that leaves a lasting impact. She is always ready to learn new things and expand...View More
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