Frozen shoulder, medically termed adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It severely limits arm movement, impacting daily activities. For most individuals, surgical intervention is not the initial treatment. Non-surgical treatments are typically the first approach, aiming to restore mobility and alleviate pain.
Understanding Frozen Shoulder
Frozen shoulder develops when the shoulder joint capsule, a strong connective tissue surrounding the joint, thickens, stiffens, and tightens. Within this capsule, thick bands of tissue, known as adhesions, can form, and the amount of synovial fluid, which lubricates the joint, may decrease. These changes restrict the shoulder’s ability to move freely.
The condition typically progresses through three distinct stages. The initial “freezing” stage involves increasing pain, often worse at night, and a gradual loss of motion, lasting from approximately six weeks to nine months. During the “frozen” stage, pain may subside, but the shoulder’s stiffness intensifies, making movement significantly difficult, a phase that can endure for two to six months or even up to a year. The final “thawing” stage sees a gradual improvement in motion and a reduction in pain, with recovery potentially taking anywhere from five months to over two years.
Several factors can increase the likelihood of developing frozen shoulder:
Age (typically affecting people over 40, especially women).
Diabetes.
Thyroid conditions (both overactive and underactive).
Prolonged immobilization of the shoulder after an injury or surgery.
Non-Surgical Approaches
For most individuals, non-surgical treatments are the primary approach for managing frozen shoulder. Pain management often begins with over-the-counter pain relievers like ibuprofen or acetaminophen to reduce pain and inflammation. In some cases, healthcare providers may prescribe stronger pain medication or anti-inflammatory drugs. Corticosteroid injections into the shoulder joint can also reduce pain and inflammation, especially in early stages, creating a window for other treatments.
Physical therapy is central to restoring shoulder movement and reducing stiffness. A therapist guides patients through specific exercises (stretching, strengthening, and manual therapy) to improve range of motion. Consistent adherence to a prescribed exercise program, whether supervised or at home, is important for progress.
Applying heat or cold to the shoulder offers additional pain relief. Heat therapy (warm compresses or heating pads) relaxes muscles and improves circulation, while cold therapy (ice packs) numbs the area and reduces inflammation. Alternating heat and cold may also be beneficial.
When Surgery is Considered
Surgery for frozen shoulder is typically considered a last resort, reserved for cases where non-surgical treatments have not yielded sufficient improvement. This usually means that conservative management, including physical therapy and medication, has been pursued for a significant period, often six to twelve months, without resolving symptoms. Surgery may become an option if the condition continues to severely limit daily activities and overall quality of life despite consistent efforts with non-invasive methods.
Before considering surgery, healthcare providers ensure that other potential conditions causing shoulder pain and stiffness have been ruled out. A clear diagnosis of primary adhesive capsulitis is important. Additionally, the patient’s overall health is assessed to ensure there are no underlying medical conditions that would make surgery unsafe.
Surgical Options for Frozen Shoulder
If non-surgical approaches are unsuccessful, two main surgical procedures are used to treat frozen shoulder. Arthroscopic capsular release is a minimally invasive procedure where a surgeon makes small incisions to insert a tiny camera and instruments into the shoulder joint. Through this approach, tight parts of the joint capsule are precisely cut to allow for greater movement.
Another option is manipulation under anesthesia (MUA). In this procedure, while the patient is unconscious under general anesthesia, the surgeon gently forces the shoulder through its range of motion. This action aims to stretch or tear the tightened capsule and break up adhesions, thereby releasing the shoulder. MUA is sometimes performed in combination with arthroscopic capsular release to achieve maximum results.
Recovery and Rehabilitation
Regardless of whether the treatment for frozen shoulder involves non-surgical methods or surgery, rehabilitation is a fundamental part of the recovery process. Physical therapy is important for regaining full range of motion and strength in the shoulder. After surgery, immediate and consistent physical therapy is often recommended to maintain the mobility achieved during the procedure and prevent the recurrence of stiffness.
The recovery timeline for frozen shoulder can be lengthy, often taking several months to over a year, and patience is important. Adherence to the prescribed therapy exercises is important for a successful outcome, as consistent effort helps the shoulder gradually regain its function.