Frozen shoulder is a medical condition in which the patient suffers from severe stiffness and constant pain in the shoulder joint, which reduces the ability to move the arm. This condition affects the quality of daily life, especially with simple tasks such as wearing clothes or lifting things. It is a condition known medically as adhesive capsulitis. It occurs due to inflammation of the tissues surrounding the joint, which leads to restriction of its movement. It mostly affects middle-aged people or those who suffer from chronic diseases such as diabetes. This condition takes a long time to treat, but it can be improved with appropriate treatment and physical exercises.

What is frozen shoulder?

Before we get to know the details of frozen shoulder, including causes, symptoms, diagnosis methods, and treatment, let us shed light on it as a medical condition. What is frozen shoulder?

Causes of frozen shoulder

The causes of frozen shoulder are varied, and are often related to factors that lead to a lack of movement of the shoulder joint or a defect in the function of the surrounding tissues. The most prominent of these causes are:

• Long periods of immobilization, such as after surgery, a broken arm, or a shoulder sprain, where the arm is immobilized for a long period of time without movement, which increases the possibility of joint stiffness.
• Previous injuries such as inflammation or tears in the shoulder tendons, which may lead to reduced use of the shoulder and the condition gradually progressing.
• Chronic diseases such as diabetes, where the chances of developing frozen shoulder increase significantly, in addition to thyroid problems, Parkinson's disease, and heart disease.
• Surgeries or strokes that force the patient to move the arm for periods of time, which impairs movement and contributes to joint stiffness.
• Age and gender: Frozen shoulder is common in people between the ages of 40 and 60, and women are affected more than men.
• Unknown causes of unknown cause. In some cases, there is no clear cause for the infection, and it occurs without a previous injury or disease.

Common frozen shoulder symptoms

Common frozen shoulder symptoms include:

• Persistent pain in the shoulder: It begins gradually and gets worse over time, especially when trying to move the arm or sleeping on the affected shoulder.
• Restriction in shoulder movement: It becomes difficult to perform daily movements such as raising the arm, combing the hair, or putting on clothes, and the stiffness gradually increases.
• Joint stiffness: This is the feeling that the shoulder is frozen or inflexible, which reduces the ability to raise the arm up or back.
• Night pain: Pain increases at night and necessarily affects sleep, causing general fatigue.
• Weakness in the shoulder muscles: As a result of lack of movement, the muscles surrounding the joint may weaken over time.
• Change in the stages of symptoms: The condition goes through three stages: the pain stage, then freezing, then thawing or recovery, and each stage may last for several months.

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Stages of development of frozen shoulder

Frozen shoulder goes through three main stages that develop gradually over several months or even years. These stages include the following:

• The pain stage or the early stage is the beginning of feeling pain in the shoulder joint. This pain gradually increases with time, and the pain is more noticeable during movement or at night. Although the range of movement may not be greatly affected at first, the pain makes the patient reduce the use of the shoulder. This stage usually lasts from 6 to 9 months.
• The freezing stage, in which the pain begins to gradually subside, but is replaced by severe stiffness in the shoulder. The range of motion also decreases clearly, and it becomes difficult to raise or move the arm backwards, and daily activities become more difficult. This stage usually lasts from 4 to 12 months.
• The recovery stage is when the shoulder begins to gradually regain its movement, stiffness decreases, and the ability to perform daily tasks improves. Complete recovery may take from several months to two years, depending on the condition and treatment used.

Methods of medical diagnosis of the condition

After you feel the symptoms mentioned above, you should go to a specialist doctor who will diagnose frozen shoulder. During the diagnosis, the diagnosis is based on a clinical examination and medical history, in addition to some imaging tests to rule out other causes. Diagnostic methods include the following:

• The doctor moves the shoulder in different directions to evaluate the extent and range of movement. He asks the patient to move his arm himself, which is the active movement. Then the doctor moves it to the passive movement in the frozen shoulder, and both movements are affected together, which distinguishes the condition from other shoulder injuries.
• The doctor asks about the symptoms, when they started, and the presence of any previous infections or chronic diseases such as diabetes, heart problems, or thyroid problems.
• X-ray imaging is used to rule out other problems such as arthritis, fractures, or calcium deposits.
• Magnetic resonance imaging (MRI) may be requested when a tendon injury or rotator cuff tear is suspected, and helps confirm the diagnosis or rule out similar conditions.
• Ultrasound is an effective tool for detecting tendon inflammation or the presence of fluid in the joint.

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Physical and medical treatment for frozen shoulder

Frozen shoulder treatment involves a combination of medical therapy and physical therapy with the goal of relieving pain and gradually restoring shoulder movement. The type of treatment depends on the stage the patient is going through, and options include the following:

Medical treatment

• Analgesic and anti-inflammatory medications include non-steroidal anti-inflammatory drugs such as ibuprofen or paracetamol to reduce pain and swelling.
• Cortisone injections are used in advanced cases to quickly relieve inflammation and reduce pain, and may contribute to temporarily improving joint movement.
• Intra-articular injection (Hydrodilatation) in which a sterile fluid is injected to expand the joint capsule and dissolve adhesions, and is performed under radiological guidance.
• Surgery: In very rare cases, if conservative treatment fails over a long period, shoulder arthroscopy or surgical release of the joint capsule can be performed.

Physical therapy

• Daily stretching exercises are gentle and regular exercises aimed at gradually increasing shoulder flexibility and improving range of motion. The exercises must be performed under the supervision of a physical therapist, especially in the early stages, to avoid severe pain.
• Heat and cold therapy, in which warm compresses are used to soften tissues before exercise, and cold compresses are used to reduce pain after exercise.
• Ultrasound and electrical stimulation: These methods are used to stimulate deep tissue, relieve muscle spasm, and improve blood circulation.
• Regular follow-up, continuity and follow-up with a physiotherapist play a pivotal role in regaining mobility and complete recovery.

The patient needs patience and commitment to the treatment plan, as the recovery journey may last from several months to more than a year, but most cases gradually improve without the need for surgical intervention.

Frequently asked questions

How long does shoulder physical therapy take?

Treatment time varies depending on the severity of the condition, but physical therapy for frozen shoulder usually takes from 3 to 9 months, and in some cases may extend up to a year, and requires daily commitment to exercises and follow-up with a physical therapist to achieve effective results.

Is olive oil beneficial for shoulder pain?

Olive oil is not considered a direct treatment for frozen shoulder, but it may help relieve pain locally when used in a light massage, because it contains natural anti-inflammatory agents. However, it does not replace basic medical and physical treatments.

Does frozen shoulder heal?

Yes, in most cases the frozen shoulder heals gradually, especially when treatment is started early and a regular physical therapy plan is followed. Complete recovery may take from one to three years depending on the case, but most patients regain the ability to move normally.

How do you know that you suffer from frozen shoulder?

If you suffer from gradual pain in the shoulder, followed by apparent stiffness and restriction of movement, especially in daily movements such as raising or moving the arm back, and the pain increases at night, these may be signs of frozen shoulder, and it is recommended to see a doctor to confirm the diagnosis.

If you feel any of the symptoms of frozen shoulder and want to get effective treatment with Al Mousa Specialist Hospital, you are in the right place where you will get accurate diagnosis and appropriate treatment with a group of the best medical teams in the Kingdom of Saudi Arabia. Book your appointment now.

المصادر:

Frozen Shoulder – physio-pedia

Frozen Shoulder (Adhesive Capsulitis) – clevelandclinic