What causes frozen shoulder? The exact cause is
unknown. The condition has been linked to auto-antibodies that attack
the joint capsule, resulting in inflammation, adhesion and eventual scar
tissue formation. It may be triggered by injury (including surgery),
degenerative changes in the joint, as well as viral illnesses. This
condition is also more common in diabetics. Your shoulder may go through
several stages as the scar tissue forms, with each stage lasting
between three to six months:
- Freezing stage – you may experience ache and mild stiffness as the disease starts. Pain worsens as the condition progresses.
- Frozen stage – pain diminishes but stiffness increases. Shoulder movements can be severely restricted.
- Thawing stage – shoulder movement improves, and you will be able to
do more activities. Complete resolution is the norm but up to 15% of
patients may have remaining movement restriction or weakness.
What will my doctor do? After a physical
examination, an ultrasound scan and X-ray may be required to exclude
other causes of pain. In the early stages, it may be difficult to tell
it apart from other painful conditions affecting the shoulder.
How is it treated?
The disease will, unfortunately, have to run its course. The goal of
treatment is to minimise pain and discomfort during the disease process
and to restore full range of motion and strength by the end of its
natural course. Your doctor may prescribe a course of anti-inflammatory
medication for symptom relief. Forceful manipulation should be avoided
as this may worsen symptoms. Hydrodilatation of the joint may be
required in severe cases. During this procedure, which is carried out
under local anaesthesia, a small volume of sterile solution is injected
into the joint to loosen adhesions.
To maintain shoulder
function, you are encouraged to perform the exercises shown. Each
exercise should be performed at least twice a day. Application of a warm
towel for 5-10 minutes prior to exercise will reduce the discomfort.
Exercise both shoulders, so that you can also maintain movement in the
healthy shoulder. If there is increased pain after exercise, ice the
painful part for 5-10 minutes.
Range of motion (ROM) exercises see pictures Assisted internal rotation
Assisted abduction
Assisted forward flexion
Scapular retraction
Stretchessee pictures Cervical, chest & shoulder stretch
Posterior capsule stretch
What is my prognosis?
Many people with frozen shoulder regain full use of their shoulder
after the condition has run its course. However, this may take 6-18
months from the onset of symptoms, and there may be some remaining pain
and stiffness. Recurrence, either in the same shoulder or the other side
can happen.