Frozen Shoulder: Symptoms and Causes

Frozen shoulder, medically known as adhesive capsulitis, is characterized by pain and stiffness in the shoulder joint, leading to a significant reduction in mobility. This condition can be debilitating, impacting daily activities and quality of life. Below, we explore the symptoms, stages, and causes of frozen shoulder.

What is Frozen Shoulder?

Frozen shoulder occurs when the connective tissue surrounding the shoulder joint (the shoulder capsule) becomes thickened and tight. This leads to the formation of scar tissue (adhesions) and a reduction in synovial fluid, which normally lubricates the joint. As a result, shoulder movement becomes restricted and painful.

This condition primarily affects adults aged 40 to 60 and is more common in women than men. It can occur spontaneously or after an injury or surgery that immobilizes the shoulder for an extended period.

Symptoms of Frozen Shoulder

The hallmark symptoms of frozen shoulder are pain and stiffness, which worsen over time and follow a predictable progression through three stages:

1. Freezing Stage

• Pain develops gradually and intensifies over time.
• Shoulder movement becomes increasingly limited.
• Pain is often worse at night, disrupting sleep.
• This stage typically lasts between 6 weeks and 9 months.

2. Frozen Stage

• Pain may decrease slightly, but stiffness persists.
• Shoulder mobility is severely restricted, making daily activities like dressing or reaching overhead challenging.
• This stage can last from 4 to 6 months.

3. Thawing Stage

• Gradual improvement in shoulder mobility occurs.
• Pain diminishes significantly as range of motion returns.
• Full recovery can take anywhere from 6 months to 2 years.

Common Signs

• A dull or aching pain localized around the outer shoulder or upper arm.
• Difficulty performing tasks that involve overhead or behind-the-back movements.
• Weakness in the affected arm due to pain or disuse.
• Crepitus (grating sounds) during movement in some cases.

Causes of Frozen Shoulder

The exact cause of frozen shoulder remains unclear in many cases. However, several factors have been identified as contributing to its development:

1. Primary (Idiopathic) Causes

In some individuals, frozen shoulder develops without any identifiable trigger. This is referred to as primary or idiopathic adhesive capsulitis.

2. Secondary Causes

Secondary frozen shoulder arises due to an underlying condition or event. These include:

a. Immobilization

• Prolonged lack of movement following surgery, fractures, or injuries can lead to stiffness and inflammation in the shoulder capsule.

1. Medical Conditions
   Certain systemic diseases increase the risk of developing frozen shoulder:

• Diabetes: People with diabetes are at a significantly higher risk (up to five times more likely) compared to non-diabetics. Their symptoms also tend to be more severe and prolonged.
• Thyroid Disorders: Both hypothyroidism and hyperthyroidism are associated with an increased risk.
• Other Conditions: Parkinson’s disease, cardiovascular disease, and autoimmune disorders have also been linked to frozen shoulder.

1. Inflammation
   Studies suggest that inflammatory processes play a key role in the development of frozen shoulder. Elevated levels of inflammatory cytokines like interleukin (IL)-1β and tumor necrosis factor (TNF)-α have been observed in affected tissues.
2. Gender and Age
   Women between 40 and 60 years old are more likely to develop frozen shoulder than men. Hormonal changes during menopause may contribute to this increased prevalence.
3. Sleep Quality
   Poor sleep has been identified as a potential risk factor for frozen shoulder due to its association with systemic inflammation.

Risk Factors: Frozen Shoulder

Several factors heighten the likelihood of developing frozen shoulder:

1. Age: Most common in individuals aged 40–60 years.
2. Gender: Women are more frequently affected than men.
3. Diabetes: Strongly associated with both primary and secondary forms of frozen shoulder.
4. Immobilization: Prolonged periods without movement due to injury or surgery.
5. Other Health Conditions: Thyroid disorders, cardiovascular diseases, Parkinson’s disease.

Also Read – Hemiarthroplasty for Femoral Neck and Head Fractures

Pathophysiology

Frozen shoulder involves both inflammatory and fibrotic processes:

• Inflammation triggers pain and swelling in the joint capsule.
• Over time, excessive scar tissue forms within the capsule, further restricting movement.
• Reduced synovial fluid exacerbates stiffness by limiting lubrication within the joint.

Complications

If left untreated, frozen shoulder can lead to:

• Chronic pain
• Permanent loss of range of motion
• Muscle atrophy due to disuse

While most cases eventually resolve on their own within 1–3 years, residual stiffness may persist in some individuals.

Prevention Tips

Preventing frozen shoulder may not always be possible, especially for those with underlying medical conditions like diabetes. However, certain measures can reduce your risk:

1. Engage in gentle range-of-motion exercises following surgery or injury.
2. Manage chronic conditions like diabetes effectively through medication and lifestyle changes.
3. Avoid prolonged immobilization by moving your shoulders regularly during recovery periods.

Exercises to Alleviate Frozen Shoulder Symptoms

To alleviate frozen shoulder symptoms, try these exercises:

• Pendulum Stretch: Swing your arm in small circles.
• Cross-Body Reach: Use your unaffected arm to stretch the affected one across your chest.
• Finger Walk: Walk your fingers up a wall to improve overhead mobility.
• Towel Stretch: Use a towel to assist stretching behind your back.

Warm up with heat therapy before exercising. But you must remember, perform these stretches gently, avoiding pain, and gradually increase intensity as mobility improves. You can consult Dr. Hemant Sharma for personalized guidance and to ensure safety. Regular exercise can help restore range of motion and reduce stiffness.

Medical Treatments

The most effective treatment for frozen shoulder depends on its stage and severity. Non-surgical options like physical therapy, medications, corticosteroid injections, and hydro-dilatation are typically sufficient for most patients. Surgical interventions like shoulder manipulation and arthroscopic surgery are reserved for severe cases that do not respond to other treatments.

Complementary therapies such as acupuncture and massage can further enhance recovery. Consulting an orthopedic specialist like Dr. Hemant Sharma ensures a personalized treatment plan tailored to individual needs. With proper care, most patients achieve significant improvement within 12–18 months. Dr hemant Sharma is Best orthopedic surgeon in Gurgaon.

Conclusion

Frozen shoulder is a challenging condition that significantly impacts daily life due to pain and restricted mobility. Understanding its symptoms, causes, and risk factors is crucial for early diagnosis and effective management. If you experience persistent pain or stiffness in your shoulder that limits your range of motion, consult Dr. Hemant Sharma promptly for evaluation and treatment options. By staying informed about this condition and taking preventive measures where possible, you can minimize its impact on your quality of life.