Conditions Frozen shoulder

The term “frozen shoulder” refers to pain and stiffness in the shoulder that develops gradually and for no apparent reason, mostly at the age of around 50.

Frozen shoulder generally clears up without treatment. It may take several months for the shoulder to stop hurting. It takes much longer for it to regain full mobility.

Medication and physiotherapy can alleviate the symptoms and improve mobility. Surgery is very rarely an option as it involves risks and the benefit is questionable.

Frozen shoulder typically develops slowly. People with frozen shoulder usually have only mild symptoms initially. The pain becomes more severe over a number of months. At that point it often disrupts people’s sleep. The pain is frequently described as dull or deep-seated. It may also radiate into the upper arm. The affected shoulder also becomes increasingly stiff: it becomes more and more difficult to move the respective arm up and back. 

Frozen shoulder can be very distressing and make many activities very difficult. Dressing, cooking, cleaning, reaching into your back pocket or changing gear whilst driving can all become challenging or even impossible. Some people with frozen shoulder are temporarily unable to do their job, particular if they frequently work above head height.

Another distressing aspect is that other people do not always fully appreciate the problem. The complaints are often difficult for outsiders to understand, since no injuries or external symptoms are visible. Frozen shoulder also often goes undiagnosed until the later stages.

Joints are the connections between two bones. In the shoulder joint, the round top of the humerus fits into the rounded socket of the scapula (shoulder blade) like a ball. A solid layer of fiber called the joint capsule surrounds this ball joint.

Frozen shoulder is a process in which excessive scar tissue (adhesions) form in the joint capsule. This tightens the tissue and the capsule shrinks. Inflammation is likely to be a key factor here. However the exact reasons for this are still not known. As a result the cause of frozen shoulder is also unclear in many cases.

In rare cases, the condition occurs following inflammation or accidents. Frozen shoulder may also occur, for example, when the shoulder is immobilized after surgery. 

In most cases, frozen shoulder begins between the ages of 40 and 60. It is estimated that 2 to 5 percent of the population will experience frozen shoulder at one time or another, with women somewhat more likely to be affected than men. 

People with diabetes are particularly likely to have frozen shoulder. This is true of 10 to 20 percent of people with diabetes. The reason for this is not yet clear.

Frozen shoulder generally clears up by itself. However it may take a long time.

Frozen shoulder develops in three stages, which overlap:

• It starts with mild pain which then becomes increasingly severe. The shoulder may also hurt at night-time and even when it is not being moved.
• The shoulder becomes increasingly immobile over time and “freezes”. The pain subsides as it becomes increasingly immobile.
• Eventually the frozen shoulder gradually clears up and mobility returns. The symptoms improve considerably after a few months.

The progression of frozen shoulder cannot be predicted precisely. Many people have almost no symptoms after a year or two. But it may be much longer before it clears up in other people. One study showed that around 6 percent continued to have severe symptoms even after just over 4 years.

Frozen shoulder normally only occurs once in people’s lives. However, some people go on to develop it in their other shoulder within the next 5 years. This occurs in between 6 and 17 percent of cases.

Shoulder problems are not always an indication of frozen shoulder. Doctors can determine whether frozen shoulder is involved from a description of the symptoms and examination of the shoulder. This involves them palpating the joint and testing the range of motion of the arm and shoulder. The doctor stands behind the patient and observes how the shoulder moves when both arms are stretched out sideways to shoulder height. If it is frozen shoulder the shoulder blade on the affected side will lift throughout the entire movement. This is not the case in a healthy shoulder.

Sometimes a shoulder X-ray is taken, or an MRI (magnetic resonance imaging) scan of the inside of the shoulder, to rule out other conditions such as arthritis. This can provide pointers to the possible cause if it is difficult to determine.

It can take a while for frozen shoulder to heal completely. However treatment can alleviate the pain. Mobility can also be improved. Initial treatment aims to alleviate pain. Later on the goal is to restore the shoulder’s mobility.

Treatment is generally conservative, i.e., does not include surgery.

Effective treatments include, for example:

• cortisone tablets or cortisone injections into the shoulder joint to treat the pain
• stretching exercises and physiotherapy to improve mobility and strength

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen in the form of tablets or creams are unlikely to be much help. The application of heat and cold is pleasant for some people.

Exercises need to be started gently, particularly in the early stages of the condition. Otherwise they may make the pain worse. It is important to avoid forcing movement and causing severe pain.

Frozen shoulder heals on its own in most cases. So surgery is not normally required. That’s also because there is no evidence that surgery brings decisive benefits. Surgical intervention also entails risks related to the operation itself and also to anesthesia.

However, doctors sometimes advise patients to have surgery if symptoms persist for several months following conservative treatment. In this case, the doctor must inform the person that they have the right to get a second medical opinion.