What Is Frozen Shoulder And Who Gets It?

I never realised quite how debilitating a frozen shoulder could be until speaking recently with a couple of patients affected by the condition. Not just a sore, stiff shoulder, frozen shoulder can be very painful and interfere with everyday tasks like showering, brushing hair and getting dressed. Unfortunately, it’s a condition that gets more prevalent as we age and can literally seem to happen overnight. It is best to seek help for this condition in its early inflammatory stages, as once the shoulder joint is frozen, “thawing” it (regaining mobility) takes longer. Some good news is that you can recover from frozen shoulder as it will get better over time, albeit slowly (up to three years!!).

What does a frozen shoulder feel like?

Also known as “adhesive capsulitis”, frozen shoulder is a painful condition of the shoulder joint. It is sometimes misdiagnosed as arthritis or rotator cuff injury. It happens when the connective tissue enclosing the shoulder joint thickens and tightens. Symptoms include:

• shoulder stiffness and pain in the shoulder joint
• a constant deep ache
• shooting pain with certain arm movements
• pain at night, often disrupting sleep
• limited motion
• muscle spasms (often during the first stage).

Signs and symptoms begin slowly, then get worse, with the activities most affected being those that require raising and rotating the arm.

Symptoms happen in three stages:

1. Freezing – any movement of the shoulder causes pain. The shoulder’s ability to move becomes limited. This stage can last 2 to 9 months.
2. Frozen – pain might lessen but the shoulder is stiffer, and using it becomes more difficult. This stage lasts 4 to 12 months.
3. Thawing – mobility begins to improve, with this stage lasting 5 to 24 months.

Who gets a frozen shoulder?

We still don’t really know why it happens, but it seems to be a condition that happens with aging – it is most common in people over the age of 40.

Frozen shoulder is very common in menopausal women. This is thought to be due to the decrease in estrogen – when this hormone drops the whole body becomes inflamed, including joints.

People who have had to keep their shoulder still for a long period of time are at increased risk of this condition e.g after breaking an arm, after a stroke, rotator cuff injury or having shoulder surgery. Not moving the shoulder during recovery from an injury also puts people at increased risk.

Frozen shoulder is more common in people with certain diseases such as diabetes, over- or underactive thyroid, cardiovascular disease and Parkinson’s.

Can it be fixed?

Most cases of frozen shoulder will start to get better on its own within 12 to 18 months. However, it is best to get treatment in the initial stages before the shoulder has actually frozen. There are several treatments that can reduce pain, inflammation and recover mobility:

• medicines such as non-steroidal anti-inflammatories (NSAIDs like ibuprofen and diclofenac) will help to decrease pain and inflammation.
• physiotherapy will introduce range-of-motion exercises to recover movement and manage pain. Targeted exercise of the inflamed tissue can help decrease inflammation.
• Corticosteroids and/or numbing medicines such as local anaesthetics can be injected into the joint. Steroids decrease pain and increase shoulder mobility especially if given soon after frozen shoulder begins.
• Hydrodilatation – sterile water is injected into the joint capsule to help stretch the tissue and make it easier to move the joint. This can be combined with a steroid injection.
• Manual therapy such as massage can improve circulation, promote healing, and increase blood flow to the affected area.
• If nothing else has helped, arthroscopic keyhole surgery will loosen the joint capsule so that it can move more freely and can remove scar tissue from inside the joint.

Seek help early if you think you are in the initial stages of frozen shoulder. It is one of those conditions where early intervention can have a big impact on how long you have the condition and lessen the impact on your quality of life.