Frozen Shoulder (Adhesive Capsulitis) Treatment in Delhi, India

Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by pain and stiffness in the shoulder, with movement becoming increasingly difficult over time. The condition typically impacts individuals between the ages of 40 and 60, with a higher prevalence among women compared to men. Notably, those with diabetes face an elevated risk of developing a frozen shoulder.

Frozen shoulder progresses through distinct stages, each marked by specific symptoms and challenges.

Stage 1: Freezing

During the "freezing" stage, pain gradually intensifies, accompanied by a diminishing range of motion in the shoulder. This stage typically lasts between 6 weeks to 9 months.

Stage 2: Frozen 

While pain may somewhat alleviate in the "frozen" stage, stiffness persists, making daily activities challenging. This stage spans approximately 4 to 6 months.

Stage 3: Thawing

The "thawing" stage sees a gradual improvement in shoulder motion. Complete recovery or a return to near-normal strength and motion usually takes from 6 months to 2 years.

The shoulder joint is enveloped in a capsule of connective tissue. A frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. The exact reasons for this thickening and tightening are unclear. However, it's more likely to happen after keeping a shoulder still for an extended period, such as after surgery or an arm fracture.

Several factors increase the risk of developing a frozen shoulder:

Age and Sex

Immobility or Reduced Mobility

Individuals who have had to keep a shoulder still for an extended period are at a higher risk. This can result from various factors, including:

• Rotator cuff injury
• Broken arm
• Stroke
• Recovery from surgery

Systemic Diseases

Certain diseases are associated with an increased risk of a frozen shoulder. These include:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Parkinson's disease

During the frozen stage of frozen shoulder (adhesive capsulitis), patients typically experience distinct signs and symptoms, including:

• Nighttime intensity: Pain in the shoulder joint is often more intense at night during the initial stages of a frozen shoulder.
• Gradual increase in pain: There is a gradual increase in the severity of pain, contributing to discomfort and reduced shoulder function.
• Pain in movement: Movement of the shoulder is associated with varying degrees of pain, ranging from mild to severe.
• Joint Rigidity: The shoulder joint exhibits rigidity, contributing to the overall limitation of the range of motion.

To diagnose a frozen shoulder, the doctor will engage in the following steps:

Evaluation of Symptoms and Medical History

The healthcare professional will inquire about the patient's symptoms and thoroughly review their medical history.

Physical Examination of Arms and Shoulders

During a comprehensive physical examination, the doctor will manipulate the patient's shoulder in various directions to assess the range of motion and identify any pain associated with movement. This examination involves passive range of motion, where the doctor moves the arm, and active range of motion, where the patient moves their shoulder. Individuals with frozen shoulders typically exhibit a limited range of active and passive motion.

X-rays

X-rays of the shoulder are routinely performed to rule out other shoulder-related issues, such as arthritis. This imaging helps ensure that the symptoms are specifically attributed to a frozen shoulder.

Advanced Imaging Tests (if necessary)

While advanced imaging tests such as magnetic resonance imaging (MRI) and ultrasound are generally not required for diagnosing frozen shoulders, they may be ordered to investigate other potential issues, such as a rotator cuff tear.

Treatment typically involves managing pain during the initial phase, with the possibility of progressing to therapy or surgery if the issue persists and natural motion recovery does not occur.

Initial Interventions

• Hot and cold compresses: Applying hot and cold compresses aids in pain and swelling reduction.
• Pain and swelling medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen are common for pain relief. Steroid injections may be prescribed for more severe pain and swelling, involving direct injection into the shoulder joint.
• Physical therapy: Physical therapists guide patients through stretching and range of motion exercises.
• Home exercise program: Patients are encouraged to continue their exercise regimen at home.
• Transcutaneous Electrical Nerve Stimulation (TENS): Using a small, battery-operated device helps alleviate pain by blocking nerve impulses.

If these initial treatments prove ineffective after about a year, additional procedures may be considered.

Manipulation Under Anaesthesia

This surgical procedure involves putting the patient to sleep while the doctor forcefully moves the shoulder to stretch or tear the joint capsule, loosening its tightness and enhancing the range of motion.

Shoulder Arthroscopy

In Shoulder Arthroscopy, the doctor performs a capsular release by cutting through the tight portions of the joint capsule. Small, pencil-sized instruments are inserted through minor incisions around the shoulder. These procedures are often combined for more optimal outcomes.

These interventions aim to address persistent pain and stiffness in the shoulder, providing options ranging from non-invasive methods to more involved surgical procedures when necessary.

While it's not always possible to prevent a frozen shoulder, there are measures you can take to reduce the risk and promote shoulder health:

Maintain Regular Shoulder Movement

• Perform regular shoulder exercises to maintain flexibility and range of motion.
• Incorporate shoulder stretches into your daily routine.

Avoid Prolonged Immobilisation

• Avoid keeping your shoulder immobile for extended periods, especially after an injury or surgery.
• If you have a sedentary job, take breaks to move and stretch your shoulders.

Control Diabetes

If you have diabetes, work with your healthcare team to manage your blood sugar levels. There is a correlation between diabetes and a frozen shoulder.

Maintain a Healthy Lifestyle

Adopt a healthy lifestyle with regular exercise and a balanced diet to promote overall well-being.

Posture Awareness

Pay attention to your posture, especially during activities that involve repetitive shoulder movements. Maintain good ergonomics to prevent unnecessary strain.

1. Are frozen shoulders painful?

Yes, frozen shoulders are characterised by pain and stiffness in the shoulder.

2.  Can frozen shoulders be cured?

While they can improve with time and treatment, a complete cure may not be guaranteed for all cases.

3. When is frozen shoulder surgery indicated?

Shoulder replacement surgery may be considered in severe cases or when conservative treatments fail to provide relief.

4. What are the best exercises for a frozen shoulder?

Range-of-motion exercises, stretching, and strengthening exercises under the guidance of a healthcare professional can be beneficial.

5. How long does frozen shoulder rehabilitation take?

Rehabilitation duration varies, but it may take several months to years to regain full shoulder mobility.

6.  How can a frozen shoulder be cured quickly? 

Quick cures are not guaranteed. Early intervention, physical therapy, and following medical advice can expedite recovery.

7. How is frozen shoulder treated nonoperatively?

Non-operative treatments include physical therapy, anti-inflammatory medications, and corticosteroid injections to manage pain and improve mobility.

8. Why is a frozen shoulder common in diabetic patients?

The exact connection is unclear, but individuals with diabetes are at a higher risk, possibly due to factors like inflammation and collagen-related changes.

9. Can a frozen shoulder cause swollen lymph nodes?

No, swollen lymph nodes are not a typical symptom of a frozen shoulder.

10. Is a frozen shoulder a permanent condition?

For many, a frozen shoulder improves with appropriate treatment, but residual stiffness may persist in some cases. It is only sometimes permanent.

Reviewed by Dr. Vikas Gupta, Director - Orthopaedics and Head - Hand & Shoulder Surgery on 4 Jan 2024.