Pain and stiffness in the shoulder? Unravel the mystery

Frozen shoulder, also called adhesive capsulitis, is a painful medical condition that affects the shoulder joint. If left untreated over a period of time, it can result in stiffness and discomfort in the area. 

The onset of this condition happens very slowly, but can cause significant disruption to everyday activities as it becomes difficult to move the shoulder. However, the good news is that it can be treated easily and quickly.

Dr Ayyappan V Nair, consultant, shoulder surgery, sports medicine and arthroscopy, Manipal Hospital, elaborates, “Essentially, the shoulder joint comprises a ball and socket structure, with the innermost layer being a capsule—a thick membrane enveloping the joint akin to a balloon.

Dr Rahul Rathod, consultant physiotherapist, Ramkrishna Mission Hospital, Khar agrees, “Frozen shoulder does not have clear cut causes.” According to him, however, numerous factors are known:

Reduced movement: A sedentary lifestyle or situations that limit shoulder motion (like previous injuries or surgical procedures) can increase the chance.

Inflammation: Underlying conditions like diabetes can make contributions to inflammation in the shoulder pill, main to stiffness.

“When this capsule becomes inflamed, it adheres tightly to the bone, resulting in the stiffness and restricted movement typical of adhesive capsulitis or frozen shoulder,” Dr Nair adds. 

Who is at risk?

Frozen shoulder, Dr Nair informs, affects various demographic groups, with diabetic patients comprising a significant portion which is around 50%. Non-diabetic individuals also experience this condition, often without a discernible cause.  

“Primary adhesive capsulitis manifests without a specific trigger, while secondary cases result from shoulder trauma or injury. Subconscious immobilisation due to pain exacerbates stiffness, as the joint’s capsule adheres, impeding movement,” he adds. 

He states that frozen shoulders are usually diagnosed through observable clinical examination, wherein the doctor can see that a person has shoulder stiffness and restricted mobility. Although primary cases lack a clear cause, according to him, secondary cases can be attributed to shoulder trauma.

What are the stages of a frozen shoulder?

For those with a frozen shoulder, it starts out as something that does not seem too serious to begin with. Frozen shoulder is a self-limiting condition or it is a self-correcting condition, discloses Dr Nair, that means over a period of one to two years, the patient will be almost absolutely normal.

Frozen shoulder progresses through three stages, as described by Dr Rathod:

Freezing stage: This degree is characterised through sluggish onset of ache, regularly worse at night time. Movement turns into steadily constrained.

Frozen stage: Pain may additionally plateau or reduce barely, however stiffness becomes excessive, appreciably restricting each day sports.

Thawing stage: This degree can be prolonged (up to two years). Pain gradually subsides, and variety of movement slowly improves.

Frozen shoulder. Dr Ayyappan V Nair informs, affects various demographic groups, with diabetic patients comprising a significant portion (Source: Freepik)

Furthermore, Dr Nair says that even though frozen shoulder can get cured by itself, treatment is only required if the person suffering from it is so uncomfortable that they cannot wait for a two-year-long period for the recovery phase to kick in.

What are the treatment options for a frozen shoulder?

Even though a frozen shoulder can get healed with time “with 80 to 90% of movement usually restored naturally” as suggested by Dr Nair, it is important to note that daily exercises and stretching can significantly help maintain the elasticity and strength of the shoulder joints. 

During the acute phase when the pain and swelling can become unbearable in some cases, interventions can aid recovery. Dr Nair says that there are various treatments in place to ease the discomfort faced by an individual. 

“Intra-articular steroid injections reduce inflammation effectively, followed by physiotherapy to improve mobility. This combined treatment typically spans two to three months, yielding excellent results under skilled physiotherapists,” he says. 

Additionally, certain lifestyle changes, Dr Rathod stresses, can help reduce the risk of developing this condition. These include:

Maintaining an active lifestyle: Regular workout helps preserve joint mobility.

Maintaining proper posture: Proper posture reduces stress on the shoulder joint.

Maintaining a healthy weight: Excess weight can put extra stress on joints.

Addressing underlying issues: Manage diabetes and other situations that could lead to infection.

One can also opt for a surgical procedure such as arthroscopic capsular release, if conservative methods fail, Dr Nair recommends. This minimally invasive procedure swiftly restores movement, often allowing patients to resume normal activities within two to three weeks, and is considered much safer than previous methods of manipulation under anesthesia, he discloses.

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