Frozen shoulder: Management and treatment options

According to health experts, the exact cause behind the ‘problem of frozen shoulder’ is still unknown but people of all ages frequently experience unexpected shoulder pain, which can have a major negative influence on everyday life and make even routine chores difficult to do. Hence, it is essential to comprehend the symptoms and the various treatments in order to manage the condition effectively and recover quickly.

The Intricacies of Shoulder Anatomy:

In an interview with HT Lifestyle, Dr Ashis Acharya, Senior Consultant Orthopaedics and Sports Medicine Unit at Sir Gangaram Hospital in New Delhi, shared, “The shoulder, often referred to as the glenohumeral joint, is remarkably flexible. This flexibility allows the arm to move in various directions. The joint consists of a ball-and-socket structure where the upper arm bone (humerus) articulates with Glenoid (scapula). Enclosing the joint is a flexible capsule filled with synovial fluid, which enables smooth and pain-free movement.”

Symptoms of Frozen Shoulder:

Dr Ashis Acharya highlighted the signs of frozen shoulder as -

• Stiffness: Frozen shoulder usually starts with stiffness, which worsens over time. The affected shoulder becomes progressively less mobile.
• Pain: Individuals with frozen shoulder experience a persistent, dull, and aching pain, especially when attempting to move the arm.
• Limited Range of Motion: One of the most distinguishing features of frozen shoulder is the significant reduction in the range of motion of the shoulder joint. Doing daily routine activities becomes increasingly difficult.
• Gradual Onset: The condition typically takes two to nine months to fully develop, and although the pain may gradually improve, the stiffness persists.

Dr Vivek Loomba, Senior Consultant Pain Physician at Indian Spinal Injuries Centre in Delhi's Vasant Kunj, insisted to not ignore these symptoms of shoulder pain -

• Persistent pain: Shoulder pain can be mild and achy or severe and stabbing. It can also vary in intensity. Shoulder movement may exacerbate the pain, which may also be localised to certain regions.
• Stiffness: A frequent sign of shoulder pain is a restricted range of motion, which makes it challenging to carry out daily tasks like reaching behind the back or overhead.
• Long term weakness: Shoulder pain can cause the affected area to lose strength, which makes jobs involving lifting or carrying things more difficult.
• Increased Instability: People who suffer from shoulder pain occasionally report feeling as though their shoulder joints are loose or may have a sensation of "popping out."
• Inflamed area: Inflammation in the shoulder joint can lead to soreness, swelling, and sensitivity in the affected area.
• Popping Sounds: When moving the shoulder, audible clicking or popping sounds may indicate a problem with the joint.

Causes and Risk Factors:

Dr Ashis Acharya said that while the precise cause of frozen shoulder remains elusive, it is widely believed that inflammation plays a pivotal role. Some known risk factors include -

• Immobilisation: A frozen shoulder can often occur when the shoulder has been immobilized for an extended period due to injury, surgery, or illness.
• Overuse Injuries: Conditions such as tendinitis or bursitis of the rotator cuff can contribute to inflammation and, subsequently, frozen shoulder.
• Underlying Conditions: Certain medical conditions like thyroid disorders or Diabetes or Parkinson's disease may increase the risk of developing frozen shoulder.

Diagnosis and Evaluation:

Dr Ashis Acharya said, “If you suspect that you may have a frozen shoulder, it is crucial to seek professional medical evaluation. Your shoulder specialist will conduct a thorough physical examination and may suggest diagnostic tests like X-rays or an MRI to rule out other underlying issues, such as rotator cuff tendinitis or tears or arthritis.”

Treatment Options:

As per Dr Ashis Acharya, the treatment for frozen shoulder focuses on two primary objectives: pain relief and restoring normal shoulder function. Common treatment options include:

• Anti-Inflammatory Medications: These are prescribed to reduce pain and swelling. Common medications include aspirin, ibuprofen or naproxen or other drugs.
• Corticosteroid Injections: These injections help alleviate inflammation in the shoulder joint or soft tissues.
• Physical Therapy: Physical therapy is often the cornerstone of treatment, with a focus on stretching exercises to regain flexibility and later on strengthening exercises. A physical therapist can guide you through these exercises, ensuring you progress safely.
• At-Home Exercises: In addition to professional physical therapy, individuals are encouraged to perform gentle, at-home exercises to maintain and improve their range of motion.
• Surgery: When non-surgical techniques don't improve the patient's quality of life, surgery is taken into consideration which may include Shoulder manipulation under anaesthesia or Arthroscopic capsular release.

Asserting that for shoulder pain – ‘a profound treatment plan is the prerequisite’, Dr Vivek Loomba recommended that the following steps are a must -

• Rest and Activity Alteration: Letting the shoulder rest and avoiding activities that make the pain worse can be the initial measures in managing shoulder pain. Enough rest allows the shoulder to heal properly.
• Physical Therapy: A custom program of stretches and strengthening exercises, created by a physical therapist, can enhance shoulder mobility, stability, and overall function.
• Medications: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help control pain and inflammation.
• Hot or Cold Packs: Using heat or cold packs to the affected shoulder can help by relieving muscle tension and reducing inflammation.
• Shoulder joint steroid injections: These injections are executed under aseptic precautions by a pain specialist. When conservative methods fail to alleviate shoulder joint issues such as frozen shoulder, these injections can be highly beneficial. These injections are a secure and efficient way to relieve discomfort. The patients benefit from not using painkillers, which can be dangerous if used repeatedly.
• Surgical Intervention: In extreme situations or if conservative therapy are ineffective, surgery may be required to relieve the shoulder pain. The purpose of surgery is to stabilise the shoulder joint or repair damaged tissues.

Additionally, he advised a few tips that can prevent shoulder pain issues:

• Maintaining proper posture helps ease shoulder pain.
• Repetitive overhead movements should be avoided as they may lead to shoulder impingement.
• To keep your shoulders strong and flexible, do frequent workouts.
• Make sure you lift objects properly to prevent putting too much strain on your shoulders.

Recovery and What to Expect:

Dr Ashis Acharya concluded, “Recovery from a frozen shoulder is a gradual process that takes several months to a few years. With diligent adherence to prescribed exercises and treatment plans, most individuals experience significant improvement without the need for surgical intervention. If you encounter difficulties or reach a plateau in your recovery, it's advisable to consult an orthopaedic sports medicine specialist.”