Shoulder

The shoulder is one of the largest and most complex joints in the body, where many muscles act to provide the widest range of motion of any part of the body. This flexibility is also what makes the shoulder prone to instability and injury.

The shoulder joint is formed where the humerus (upper arm bone) fits into the scapula (shoulder blade), like a ball and socket. The clavicle (collarbone) extends across the front of the shoulder from the sternum to the scapula and helps stabilize the shoulder’s movements.

Frozen Shoulder

WHAT IS A FROZEN SHOULDER?

Frozen shoulder, also known as adhesive capsulitis, is a shoulder condition that causes pain and stiffness in your shoulder joint. When the tissues in your shoulder joint become thicker and tighter, scar tissue develops over time. As a result, your shoulder joint doesn’t have enough space to rotate properly and becomes very hard to move. This pain and stiffness usually begins gradually, worsens over time and then finally goes away. This can take anywhere from a year to 3 years.

WHAT ARE THE SYMPTOMS OF A FROZEN SHOULDER?

Typical signs and symptoms of a frozen shoulder are severe pain and being unable to move your shoulder. This pain may also worsen at night, making it difficult to sleep.

There are 3 stages to a frozen shoulder:

  • Freezing stage
    • You experience pain in your shoulder every time you move it
    • Your range of motion starts becoming limited
    • This stage typically lasts between 6 weeks to 9 months
  • Frozen stage
    • Your pain reduces during this period, but stiffness of your shoulder remains
    • It is more difficult to use your shoulder for daily activities
    • This stage typically lasts between 4 to 6 months
  • Thawing stage
    • Your start to regain your range of motion
    • Pain may improve, but may recur from time to time
    • This stage typically lasts between 6 months to 2 years

 

WHAT ARE THE CAUSES AND RISK FACTORS OF A FROZEN SHOULDER?

The causes of a frozen shoulder are not fully understood. However, we do know that certain groups of people are more at risk than others.

Risk factors of a frozen shoulder include:

  • Age: 40 years and older
  • Gender: Women have higher risk of developing a frozen shoulder compared to men
  • Being immobilized for long periods of time: if you previously had a stroke or surgery
  • Endocrine conditions: diabetes and thyroid problems
  • Diseases: Parkinson’s and cardiac disease
  • Trauma or injury: eg. Fractures

 

WHAT IS THE DIAGNOSIS OF A FROZEN SHOULDER?

Your Doctor will first check on the symptoms and history of the injury, before conducting a physical examination of your shoulder. Your doctor will check on your range of motion passively (Doctor will move your arms himself) and actively (Doctor will get you to do the movement yourself). By doing this, he can assess your range of motion by seeing how far you can move your arm and how badly it hurts.

Imaging tests such as an X-ray, ultrasound or MRI may be ordered by your doctor to help rule out other conditions that may cause stiffness and pain, such as arthritis or a torn rotator cuff.

 

WHAT ARE THE TREATMENT OPTIONS FOR A FROZEN SHOULDER?

Frozen shoulder generally improves over time, even though it may take up to 3 years. Treatment for frozen shoulder aims to control the pain and restore motion and strength in the shoulder joint.

Most people improve with non-surgical treatments. These include:

  • Physical Therapy

The most common form of treatment, you will learn a range of motion exercises to help restore mobility in your shoulder under the guidance of a physiotherapist. These include simple stretching exercises which can be done at home.

  • Medications

Over-the-counter or prescription non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed by your doctor to relieve pain and inflammation of the shoulder joint.

  • Steroid injections

A corticosteroid such as cortisone can be injected directly into your shoulder joint to relieve severe pain and swelling.

  • Hydrodilatation

This involves gently injecting a large volume of sterile fluid into the shoulder joint to expand and stretch the shoulder joint capsule.

  • Hot or cold compress

Application of a hot or cold compress to the affected area to reduce mild pain

 

Should non-surgical treatments fail to work, your doctor may advise surgery. This is typically offered during the Frozen stage (stage 2) of your frozen shoulder. Surgical options include:

  • Manipulation under anaesthesia

During this procedure, you will be unconscious and your doctor will force your shoulder past the limited range. This causes the tissues of the joint capsule to stretch or tear, releasing the tightening and increases range of motion.

  • Shoulder arthroscopy

During this procedure, incisions will be made around your shoulder. Your doctor will insert pencil-sized surgical tools to cut through the tight tissues of the joint capsule.

In many cases, manipulation and arthroscopy are used together to obtain the best results. Most patients have good outcomes with these procedures.

 

RECOVERY AFTER SURGERY

If you have done surgery for your frozen shoulder, recovery time after surgery can vary from 6 weeks to 3 months. Physiotherapy is necessary to maintain the motion achieved with surgery, and to improve your range of motion. Long-term outcomes are generally good, with most patients having reduced or no pain, and an improved range of motion.

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