Frozen Shoulder

A Frozen shoulder, also known as adhesive capsulitis/ Periarthritis of the shoulder, is a condition characterized by pain and stiffness in the shoulder joint. It typically progresses through stages and can last for an extended period, often resolving gradually over time. The condition can significantly limit the range of motion in the affected shoulder, making it difficult to perform everyday activities.

Dr. Vishnu Unnithan has done extensive research in Frozen shoulder and presented papers in National (IASCON 2018, Calicut) and International (SICOT Orthopaedic World Congress 2018 Montreal, Canada) conferences regarding the above condition and its treatment. He has also given talks at various conferences about the above condition.

Even though Frozen Shoulder was considered as a self limiting condition, current evidences tell us that long-term disability is seen in 10% to 20% of the patients and persistent symptoms are seen upto 30% to 60% of patients in the long run.

Here are some key points to know about frozen shoulder:

All stiff and painful shoulders are not Frozen Shoulder
Many a times frozen shoulder can be secondary to an underlying pathology like a torn shoulder muscle tendon, or an injury
A good number of people with frozen shoulder can have diabetes or thyroid disorders.

Causes

The exact cause of frozen shoulder is not always clear, but several factors may contribute to its development, including:

Injury or trauma to the shoulder
Prolonged immobilization of the shoulder joint (e.g., after surgery or injury)
Certain medical conditions such as diabetes, heart disease, or thyroid disorders
Inflammatory conditions

Symptoms

The primary symptoms of frozen shoulder include pain and stiffness in the shoulder joint with varying degrees of each. The condition typically progresses through three stages:

Freezing stage: Gradual onset of pain and increasing shoulder stiffness.
Frozen stage: Pain may decrease, but stiffness and limited range of motion persist.
Thawing stage: Range of motion slowly improves, and pain diminishes.

Diagnosis

We at our centre typically diagnoses frozen shoulder based on a physical examination, medical history, and imaging tests (e.g., X-rays, MRI) to rule out other possible causes of shoulder pain and stiffness.

Treatment

Treatment for frozen shoulder aims to relieve pain and improve range of motion. Common treatment options include:

Physical therapy: Almost all of our patients require only shoulder specific exercises which concentrate on stretching and strengthening their shoulder muscles and stretching the shoulder capsule.
Pain relief: Over-the-counter pain medications or prescribed pain relievers.
Heat or ice application: Applying heat or ice to the affected shoulder can help reduce pain and inflammation.
Corticosteroid injections: In some cases, injections of corticosteroids into the shoulder joint can help reduce pain and inflammation.
Joint distension: Injecting sterile water into the joint capsule to stretch it and improve mobility using ultrasound guidance.
Manipulation under anesthesia: We don’t recommend this treatment nowadays due to the high risk of injuries which can occur while manipulating the shoulder.
Surgery: Arthroscopic capsular release Surgery is typically considered as a last resort and it involves releasing the joint capsule or removing scar tissue to rapidly regain shoulder movements in patients whom conservative treatment have failed.

Prognosis

Frozen shoulder can be a painful and frustrating condition, but it often improves over time with appropriate treatment and physical therapy. The recovery process can be slow, and it may take several months to regain full range of motion in the shoulder.

It's important for individuals experiencing shoulder pain and stiffness to seek medical evaluation and guidance for appropriate diagnosis and treatment, as untreated frozen shoulder can lead to long-term limitations in shoulder function.