Frozen Shoulder Treatment Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Frozen shoulder is a condition in which the capsule of the joint becomes inflamed, thickened and stiff, hence severely restricting movements of the joint.
Patients with this condition are often middle-aged or elderly. It is vital to understand your symptoms and seek medical treatment as soon as possible, as early diagnosis and management can reduce the complications of frozen shoulder.
What Is Frozen Shoulder?
Frozen shoulder, or adhesive capsulitis, is a common condition that affects 2% to 5% of the general population and up to 20% of individuals with diabetes.
The condition is characterised by stiffness and pain in the shoulder joint, leading to restricted movement. It can affect the entire shoulder area, from the base of the neck to the tip of the shoulder, both front and back. It often causes pain and limited motion, which can sometimes be confused with issues from the cervical spine (neck) or other shoulder problems.
Shoulder pain can also be linked to specific activities, such as overuse during sports like tennis or volleyball or from gym exercises like bench presses or shoulder presses.
What Causes Frozen Shoulder?
- Inflammation: Inflammation in the shoulder joint leads to the thickening and tightening of the joint capsule. This process restricts the shoulder joint’s movement, ultimately causing the shoulder to become stiff and immobile.
- No Apparent Cause: Sometimes, it can occur without an obvious reason. This is referred to as a primary frozen shoulder and can develop spontaneously with no preceding injury or condition.
Risk Factors for Frozen Shoulder
While the exact causes of frozen shoulder are unclear, the following factors and conditions can increase the risk of developing it:
Age (40 years and older)
Frozen shoulders tend to be more common in people over 40, with the risk increasing as we age.
Prolonged Immobility
Keeping your shoulder immobilised for long periods, whether due to injury or other reasons, can lead to frozen shoulder.
Rotator Cuff Injury
Injuries to the rotator cuff can limit shoulder movement, increasing the risk of frozen shoulder.
Recovery from Surgery
Post-surgical immobility, especially after shoulder or chest surgery, can contribute to frozen shoulder.
Broken or Fractured Arm
A broken or fractured arm can restrict shoulder movement during healing, raising the risk of developing frozen shoulder.
Diabetes
Individuals with diabetes are more prone to frozen shoulder, with studies showing that it occurs more frequently in diabetic patients.
Thyroid Disorders
Conditions such as hyperthyroidism or hypothyroidism can also increase the risk of frozen shoulder
Cardiovascular Diseases
People with cardiovascular diseases are more susceptible to developing frozen shoulder, although the exact reasons are not fully understood.
Tuberculosis
Tuberculosis can cause joint inflammation, including in the shoulder, increasing the likelihood of frozen shoulder.
Stroke
Stroke survivors often have limited mobility, leading to frozen shoulder due to prolonged immobility.
Symptoms of Frozen Shoulder
Frozen shoulder often starts with pain and stiffness, making moving your shoulder challenging. Here’s a breakdown of what to expect:
Pain and Stiffness
The most common issues are pain and stiffness that limit your mobility. You’ll likely feel the pain in your arm under the deltoid muscle.
Initial Mild Injury
It might begin with a seemingly insignificant incident like a slight jerk while commuting or a mild twinge when reaching for something. This pain can gradually worsen over the next few weeks or months.
Varying Pain Intensity
For some, the pain can be a mild, nagging discomfort; for others, it can be severe enough to interfere with daily activities.
Movement Restrictions
You may experience stiffness, especially when trying to rotate your arm inward. For example, men might find it challenging to put their wallets in their back pockets, and women might struggle to reach behind to clasp their bra.
Weakness
You might also feel a weakness in your arm, primarily due to the pain when lifting things or moving your shoulder beyond its limited range.
Stages of Frozen Shoulder and Symptoms
Frozen shoulder, also known as adhesive capsulitis, progresses through three distinct stages, each with its own set of symptoms. Understanding these stages can help you recognise the progression of the condition and seek timely treatment.
Stage 1: Freezing Stage
- Characterised by the gradual onset of shoulder pain, which can worsen over time.
- Pain tends to be more intense at night and may disrupt sleep.
- Shoulder movement becomes increasingly difficult, with stiffness progressively developing.
- This stage can last anywhere from 6 weeks to 9 months, with pain levels gradually increasing while mobility decreases.
Stage 2: Frozen Stage
- In this stage, the pain may begin to subside, but the stiffness remains and often becomes more pronounced.
- Shoulder mobility is significantly limited, making daily tasks challenging.
- Pain is less intense than in the freezing stage but is still present, especially at the ends of the shoulder’s range of motion.
- The frozen stage typically lasts 4 to 12 months, during which the shoulder remains stiff and limited in movement.
Stage 3: Thawing Stage
- The final stage marks a gradual improvement in shoulder mobility and reduction in stiffness.
- Pain continues to decrease as the shoulder slowly regains range of motion.
- Functionality gradually returns, though recovery can be slow and may take several months.
- The thawing stage can last from 6 months to 2 years, with continued improvement over time.
How Is Frozen Shoulder Diagnosed?
Your doctor will physically examine your shoulders to check for symptoms such as pain or joint stiffness as well as test the shoulder’s range of motion and mobility.
Additional diagnostic tests may also be performed to obtain further information on the shoulder joints or to rule out other possible problems:
- X-rays can reveal problems in the shoulders, such as arthritis.
- MRI scans provide more detailed images of the shoulder joints to help identify other problems, such as a torn rotator cuff.
How Is Frozen Shoulder Treated?
Treatment of frozen shoulders depend on the phase at which the patients present. Generally, treatment comprises pain relief and physiotherapy.
Most frozen shoulders will resolve with time and noninvasive treatment modalities as described above. However, not all do. For cases that fail to improve, invasive treatment options may be required.
Common non-surgical treatment methods include:
- Taking over-the-counter pain relievers, such as aspirin, ibuprofen or etoricoxib, can help reduce pain and inflammation
- Physical therapy
- Corticosteroid injections
- Joint distension or injecting sterile water into the joint capsule to stretch and tear the tissue and improve mobility
Surgery may be recommended if your symptoms worsen or if non-surgical treatment options are ineffective.
Some of the common surgical treatment options include:
- Manipulation under anaesthesia. This procedure involves moving your shoulder joints in different directions to tear the tightened tissue, so as to increase the shoulder’s mobility. Shoulder manipulation is typically performed under general anaesthesia.
- Surgery. Surgery for frozen shoulder rapidly relieves pain and restores shoulder mobility. Surgery is typically conducted arthroscopically, where your doctor will create 2 small incisions around your shoulder before inserting a camera into the shoulder joint, allowing the thickened capsule to be divided under direct vision. It is a very safe and effective treatment for frozen shoulders.
Exercises for Frozen Shoulder
Gentle exercises can be highly beneficial for improving shoulder mobility and relieving stiffness associated with frozen shoulders. Here are some recommended exercises to help you regain range of motion. Always consult with a frozen shoulder specialist in Singapore before starting any exercise programme to ensure it’s safe for your condition.
Pendulum Stretch
- Begin by standing with a slight bend at the waist, letting your affected arm hang down.
- Slowly swing your arm in small circles, about 10 to 15 times in each direction.
- Gradually increase the diameter of the circles as your shoulder becomes more flexible.
- This gentle stretch helps to relieve stiffness without straining the shoulder.
Towel Stretch
- Hold one end of a towel in your good hand and place it behind your back.
- Grasp the opposite end of the towel with your affected hand.
- Slowly pull the towel upward with your good hand, gently stretching your affected shoulder.
- Repeat this exercise 10 to 15 times to improve shoulder flexibility.
Cross-Body Arm Stretch
- Bring your affected arm across the front of your body, holding it with your good arm just above the elbow.
- Gently pull your arm across your chest until you feel a stretch in the back of your shoulder.
- Hold the stretch for 15 to 30 seconds, then relax. Repeat 3 to 5 times.
- This stretch helps to increase flexibility in the shoulder joint.
Armpit Stretch
- Use your unaffected arm to lift your affected arm onto a surface such as a shelf at chest level.
- Slowly bend your knees to open up the armpit, stretching the shoulder area.
- Bend deeper as you feel comfortable, holding for 10 to 15 seconds before returning to the starting position.
- Repeat this stretch 10 to 15 times to gradually improve shoulder range of motion.
Finger Walk
- Stand close to a wall, facing it, with your fingertips of the affected arm on the wall at waist level.
- Slowly “walk” your fingers up the wall, inching them as high as you comfortably can without lifting your shoulder.
- Once you reach your maximum stretch, hold for a few seconds, then walk your fingers back down.
- Repeat this exercise 10 to 20 times to gently increase shoulder flexibility.
Outward Rotation with Exercise Band
- Attach an exercise band to a closed door or stable object.
- Hold the other end of the band with your affected arm, keeping your elbow at a 90-degree angle close to your body.
- Slowly rotate your forearm outward, keeping your elbow pressed against your side.
- Return to the starting position and repeat 10 to 15 times. This strengthens the shoulder muscles and enhances joint stability.
Anatomy of the Shoulder Joint
The shoulder joint is made up of 3 bones: the shoulder blade (scapula), the humeral head and the collar-bone (clavicle).
Movements around the shoulder involve 3 separate articulations: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic articulation. When the arm is raised, the majority of movement occur at the glenohumeral joint and the scapulothoracic articulation.
The glenohumeral joint is a ball and socket joint, comprising the socket (the glenoid) and the ball (the humeral head). Both surfaces of the joint are covered with an extremely smooth and rubbery cartilage (known as articular cartilage).
The smooth surfaces create a frictionless articulation when lubricated with a small amount of joint fluid. The glenohumeral joint is housed within a strong covering known as the capsule. The capsule keeps the joint separate from the surrounding tissues like muscles.
In normal, healthy shoulders, the capsule has a pale pearly appearance, and is rather thin (1-2mm perhaps).
Frequently Asked Questions
What kind of invasive treatments are there?
Is frozen shoulder serious? When should I visit a doctor?
Can frozen shoulders be prevented?
What will the doctor do?
What tests can be done to confirm the diagnosis?
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