Frozen Shoulder: What Doctors Want You to Know Before It Gets Worse

What is Frozen Shoulder?

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by progressive pain and stiffness in the shoulder joint. It results from inflammation and thickening of the joint capsule, causing a restricted range of motion and functional limitation.

Moreover, frozen shoulder often develops gradually and may significantly affect everyday life, such as reaching overhead, dressing, and sleeping comfortably. Although many patients eventually experience improvement over time, the duration and severity can vary.

Understanding the Shoulder Joint

The shoulder is a ball-and-socket joint that allows a wide range of motion. It is supported by:

• A fibrous joint capsule
  
• Ligaments
  
• Tendons and muscles
  
• Synovial fluid
  

In the frozen shoulder, the joint capsule becomes inflamed and fibrotic. Adhesions may form within the capsule, limiting mobility and causing pain during movement.

Stages of Frozen Shoulder

Frozen shoulder typically progresses through three stages:

1. Freezing Stage  0 – 3 ml

• Gradual onset of shoulder pain
  
• Increasing stiffness
  
• Pain often worsens at night
  

2. Frozen Stage  3 – 12 ml

• Reduced pain intensity in some cases
  
• Marked limitation in active and passive movement
  
• Functional impairment in daily tasks
  

3. Thawing Stage  12 – 18 ml

• Gradual return of motion
  
• Decreasing stiffness
  
• Functional improvement over time
  

The entire course may last several months to more than a year, depending on individual factors.

Risk Factors

Frozen shoulder is more commonly found in:

• Adults aged 40–60 years (Females more than males)
• Individuals with diabetes mellitus
• Patients with thyroid disorders
• Those recovering from a shoulder injury or surgery
• Individuals with prolonged shoulder immobilization
• Usually resolves after 12-18 months
  

Diagnosis

Medical History: Assessment of symptom duration, pain characteristics, and functional limitations.

Physical Examination: Evaluation of active and passive range of motion. A hallmark finding is restriction in both directions, particularly external rotation.

Imaging Studies:

• X-rays to exclude arthritis or structural abnormalities
  
• MRI or ultrasound when differential diagnosis is necessary
  

Imaging helps rule out other shoulder conditions, such as rotator cuff tears or osteoarthritis.

Treatment Approaches

Treatment options depend on the stage and severity of symptoms and the patient’s health profile.

Non-Surgical Treatment: 

• Medications: Non-steroidal anti-inflammatory medicines (NSAIDs) may be prescribed to manage pain and inflammation
• Steroid injections: This approach involves injecting corticosteroids directly into the shoulder joint to provide significant pain relief.
• Physical Therapy: A personalized physiotherapy program can guide and ensure proper ways to improve the range of motion.

The objective is to reduce inflammation, preserve mobility, and minimize functional decline. Response to treatment varies among individuals. 

Surgical Intervention

In cases where significant stiffness persists despite appropriate conservative therapy, the following surgical options may be considered.

Surgical and other procedures 

• Joint distension: This approach is also known as hydrodilatation. The doctor will inject sterile fluid into a stiff joint. This injection stretches the capsule and breaks down scar tissue.
• Manipulation under anesthesia (MUA): This approach involves moving a stiff joint through its full range of motion while the patient is comfortably asleep. This breaks down scar tissue and adhesions that limit movement. Manipulation under anesthesia can significantly improve joint mobility, reduce pain, and increase the ability to engage in daily tasks.
• Surgery: If frozen shoulder symptoms worsen, surgical intervention might become the most effective course of action. Arthroscopy is a well-established surgical technique that offers a minimally invasive approach to treatment. This procedure uses an arthroscope inserted through a small incision into the joint cavity, enabling direct visualization of the joint structures. The doctor will cut through the tight part of the shoulder joint and remove scar tissue. This procedure will help the patient regain a broader range of motion in the shoulder.

Frozen shoulder (adhesive capsulitis) can be a debilitating condition, but with proper diagnosis and treatment, regaining a full range of motion and returning to your usual lifestyle is certainly achievable. If you suspect you might have a frozen shoulder, consult a doctor specialized in shoulder joint surgeries to discuss the best course of treatment for you. Recovery from frozen shoulder takes time. Be patient with yourself throughout the process. With perseverance and proper guidance, you can overcome frozen shoulders and reclaim control of your shoulder function.

Dr. Sakkarin Bhaka, a sports medicine and shoulder joint surgeon at Vejthani International Hospital, focuses on diagnosing and treating shoulder disorders, including adhesive capsulitis and complex joint conditions. His clinical approach emphasizes: 

• Accurate differential diagnosis
  
• Stage-specific treatment planning
  
• Minimally invasive surgical techniques

Patients with underlying metabolic conditions, particularly diabetes, may experience prolonged recovery and require personalized treatment management.

For more information, please contact

Orthopedics Center, Vejthani Hospital.
Call: (+66)2-734-0000 Ext. 2298
English Hotline: (+66)85-223-8888

Medically Reviewed by

DR. SAKKARIN BHAKA

Orthopedics

Sport Medicine and Shoulder Joint Surgery

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