Defrosting the Frozen Shoulder

Imagine trying to wash your hair in the shower and can’t lift your arm up to do it. Fingers, hand, and forearm move freely and unhindered. However, there is either pain or no movement of your arm around the shoulder. Your shoulder is “frozen”. Frozen shoulder, aka adhesive capsulitis, caused pain and stiffness in your shoulder joint (www.mayoclinic.org). Depending on the severity of the “freezing”, this condition can have a profound effect on daily living activities and cause chronic pain.

Frozen shoulder is most commonly seen in a person whose shoulder is kept still for a long period of time. The shoulder joint is normally encased in a capsule of connective tissue. A shoulder can become frozen when the capsule thickens and restricts the shoulder moving (see Figure 1). It is usually seen in those over 40 years old and is more common in women. Risk factors include having surgery, breaking an arm, recovering from stroke or other occurrences that involve having to keep the arm still for a long time. Other systemic risk factors include diabetes, thyroid disorder, Parkinson’s disease, and cardiovascular diseases.

Frozen shoulder usually onsets gradually over months. It is usually divided into three phases (NHS Inform).

Phase 1, the freezing phase, begins with pain when reaching out for things. Freezing occurs over a period of 2-9 months.

Phase 2, the frozen phase, as the name implies is when the shoulder becomes stiff and cannot move. Pain is stable or even improved. This takes 4- 12 months.

Phase 3, the thawing phase, happens as the shoulder begins to start moving again. This can take a year or longer to regain mobility.

Treatment includes observation, physical therapy, and steroid injections. Many cases of frozen shoulder improve on its own which can take over a year to occur. Specific exercises targeting moving, stretching and strengthening the shoulder joint can help improve the pain and movement of the shoulder joint. Corticosteroid injections can be considered to reduce pain and inflammation of the shoulder during recovery. Rarely is arthroscopic surgery required to break up the stiffened capsule to regain shoulder movement.