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Frozen Shoulder 

About Frozen Shoulder

Frozen Shoulder, also called Adhesive Capsulitis, is characterized by a restriction of movement of the shoulder joint due to inflammation.
Current studies have not revealed a clear cause for the condition. In Singapore, the condition may be referred to as the “50-year shoulder” because it occurs in patients around 50 years of age.

What Causes Frozen Shoulder?

A frozen shoulder happens when the connective tissue surrounding the shoulder joint capsule becomes stiff, thick and inflamed – forming scar tissues known as adhesions. These adhesions limit the movement of the shoulder and cause pain.

There is no clear cause for a frozen shoulder but there are several medical conditions risks factors such as:

  • Diabetes mellitus
  • Thyroid disorder
  • Parkinson’s Disease
  • Cancer
frozen shoulder pain

More often, the following causes may start a frozen shoulder condition:

  1. Injury of the shoulder – an outstretched arm, over-reaching to the back of the car or reaching out to tap the cash card from the car window is a common trigger. Heavy lifting such as wet laundry to hang outside of the flat will overstrain the shoulder and arm muscles.  Obvious trauma such as a fall on an outstretched arm or landing on an affected shoulder or excessive gym weight lifting maybe injures the rotator cuff of the shoulder.  Weekend warrior excessive exercises may trigger a strain in the shoulder muscles. 
  2. Menopausal syndrome – During peri-menopausal, the fluctuation and waning of estrogen will cause increased stiffness and loss of suppleness of muscles and ligaments. Once tightness and spasms set in, it will increase the likelihood of the development of a frozen shoulder without any need for injury. 
  3. Aging – slowing of metabolic rate. As one age, the muscles are more deconditioned and less supple.  Minor injuries without actual trauma can cause a sprain in the rotator cuff.  As the muscles are weaker and less able to tolerate stress, compounded by poor blood supply to the shoulder joint, a simple sprain may progress to a serious frozen shoulder. 

Stages of Frozen Shoulder

Freezing Stage
This is the most painful stage of the Frozen Shoulder. The pain will increase gradually and may become worse at night. Shoulder movement will be limited. This stage usually occurs for 6 to 36 weeks.
Frozen Stage
Pain may lessen at this stage, but the shoulder remains stiff making it difficult to do daily tasks and activities. This stage can last 2 to 6 months.
Thawing Stage
During this stage, shoulder mobility slowly improves as the pain lessens. The recovery is gradual, but it can take up to 2 years.

A Message About Frozen Shoulder

Frozen shoulder management should be targeted at preventing Stage 2 of the frozen stage from happening. During Stage 1, where the shoulder is painful and starting to develop stiffness, it is best to seek correct medical treatment. Inappropriate treatment such as excessive physical manipulation or painful massage can accelerate it into Phase 2. Specialised injections during Stage 1 can reverse the entire process and break the cycle completely.

Other complications such as torn rotator cuff or tendon tears may complicate the healing of a Frozen shoulder. In those cases, selected patients may have to undergo surgical repair of the torn tendons before undergoing intensive rehabilitation to mobilise the contractured shoulder.

In the late stage of Frozen Shoulder, physiotherapy and active rehabilitation are the cornerstones of recovery.

Diagnosing Frozen Shoulder

Here at Singapore Paincare, our team of experienced primary care physicians and pain care specialists together with an orthopedic surgeon will evaluate your condition. This includes a physical exam, questions about your symptoms and an evaluation of your medical history. Additional tests are also carried out such as nerve conduction or electromyography, these tests help to identify characteristic symptoms to eliminate other forms of disease or injuries. An X-ray or MRI scan may be needed to investigate the causes of your frozen shoulder.

What Treatments Are Available for Frozen Shoulder?

At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Our approach to pain resolution focuses on the removal of pain generators via specialised injection and minimally invasive procedures. Combined with pharmacological treatments and cognitive and physical rehabilitative therapies – we help patients improve functions and prevent pain from recurring..

Non-Surgical Treatments for Frozen Shoulder

Nerve Blocks and Cortisone Injections

Nerve blocks are done by our pain specialists to stop the pain and allow for the inflammation to subside. This is often done in conjunction with the other treatment methods for effective outcomes. Stopping pain is the mainstay of treatment during the early stages of frozen shoulder. Once pain is controlled, the patient will naturally be able to mobilise the shoulder which has not started going into stricture or contracture.

Painkillers such as potent anti-inflammatory agents are not adequately effective for frozen shoulder. There is the additional element of stiffness and spasm which painkillers are not able to treat. Targeted Cortisone injections are offered by our specialists to decrease the inflammation in the Frozen Shoulder Joint, it is done to the muscles and ligaments surrounding it. These Cortisone nerve blocks have a dual action, stopping the pain and reversing the injury.

Platelet Rich Plasma (PRP)

During nerve block of shoulder joints, instead of using cortisone, PRP may be used to heal the injured tendons and bring forth improved blood flow into the adhesive capsulitis shoulder. This prolotherapy principle will increase blood circulation, reduce oedema and swelling and cause healing with fibroblastic proliferation, giving an earlier recovery..

Joint Manipulation under Anaesthesia

For Stage 2 Frozen Shoulder, it is necessary to break up the adhesions formed within the shoulder capsule, to break free the contractures and strictures holding the shoulder in a restrictive position. Under Anaesthesia, the shoulder muscles are relaxed and manipulation of the shoulder joint can be carried out safely without risk of fracture or dislocation.

Physical Therapy
The therapy sessions by our specialists involve resistance training to reduce pain. It also consists of stretching exercises to increase the motion of the joint and minimize loss of muscle. However, the intensity and type of exercise may differ based on the conditions of the patient. Rehabilitation to recover back to fully functional status depends on the patient’s starting point. If they are in late Stage 2 with severe contracture, the recovery phase is protracted and prolonged. Hence, patients should be treated adequately through injections to break the pain cycle to get into the Stage 3 thawing phase.

Surgical Treatment for Frozen Shoulder

Frozen shoulder in the early stages is usually treated with non-surgical methods. However, if the pain does not respond to the above treatment methods surgery may be an option. This is not to treat the frozen shoulder but its related causes of frozen shoulder, such as torn tendons, arthritis of the shoulder, or bone spurs of the acromion.

Arthroscopic Surgery
In severe cases, arthroscopic surgery is carried out. The process involves using a small camera and instruments to insert into the affected joint to cut through the tight portions of the joint capsule. This attempts to free the adhesions via surgical removal through a small scope into the capsule of the shoulder.

How Can I Prevent Frozen Shoulder?

It is possible to prevent or lessen the risk of a frozen shoulder if physical therapy is started soon after any shoulder injury that makes shoulder movement painful or inconvenient.

Seek correct treatment early during Stage 1 and not wait until it becomes frozen.

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