Frozen shoulder is a painful condition that significantly restricts shoulder movement. It occurs when the connective tissue (capsule) surrounding the shoulder joint becomes inflamed and thickened, leading to adhesions that limit mobility.

Causes

• Injury: Trauma to the shoulder, such as a fall or fracture, can trigger inflammation, increasing the risk of frozen shoulder.
• Surgery: Post-surgical immobility, particularly after rotator cuff procedures, can contribute to its development.
• Medical Conditions: Diabetes, thyroid disorders, and cardiovascular diseases are linked to a higher incidence of frozen shoulder.
• Prolonged Immobilization: Extended periods of inactivity following injury or surgery can lead to stiffness and restricted movement.

Symptoms

• Pain: Initially mild but progressively worsening, the pain can be persistent or aggravated by movement.
• Stiffness: The shoulder joint becomes increasingly stiff, making movement difficult in all directions.
• Loss of Motion: Everyday activities such as reaching overhead, combing hair, or dressing become challenging.

Stages of Frozen Shoulder

1. Freezing Stage: Progressive pain and stiffness limit movement.
2. Frozen Stage: Pain may decrease, but stiffness persists, severely restricting mobility.
3. Thawing Stage: Gradual improvement in pain and range of motion.

Treatment Approach (by Dr. Pratya Jaratjitwilai)

A diagnosis is confirmed based on clinical signs and symptoms, often with unremarkable X-ray findings. Treatment focuses on breaking the cycle of pain and stiffness:

1. Pain Management

• Cortisone Injection: Administered under ultrasound guidance, corticosteroid injections offer pain relief in about 80% of patients within 3–5 days.
• Managing Underlying Conditions: If the patient has diabetes or thyroid disease, consultation with a specialist is recommended.

2. Stretching & Physical Therapy

• Once pain is under control, structured stretching exercises, with or without physical therapy, are initiated to restore movement.

3. Advanced Interventions If pain and stiffness persist, further treatment options include:

Manipulation Under Anesthesia (MUA)

A day-case procedure performed under general anesthesia:

• The surgeon manually manipulates the shoulder joint to break adhesions and restore mobility.
• A corticosteroid injection is often administered at the end of the procedure to reduce inflammation.

Potential Risks of MUA:

• Fracture: Rare but possible injury to the humerus (upper arm bone).
• Nerve Injury: Minimal risk of nerve damage leading to numbness or weakness.
• Rotator Cuff Tear: Pre-existing rotator cuff injuries may worsen or develop.

Post-procedure, physical therapy is essential to maintain the regained range of motion. Most patients experience noticeable improvement within weeks.

Arthroscopic Capsular Release

A minimally invasive surgical procedure:

• Specialized instruments are used to remove thickened and contracted capsule tissue.
• Direct visualization of adhesions allows for targeted removal, reducing the risk of recurrence.

Potential Risks:

• Infection: Rare but possible at incision sites.
• Nerve Injury: Small risk of nerve damage affecting movement.
• Persistent Stiffness: In some cases, stiffness may return post-surgery.

Post-Surgical Recovery

• Physical therapy is crucial for regaining mobility and strength.
• Most patients experience significant improvement within weeks to months.

Prevention Strategies

• Maintain Shoulder Mobility: Regular stretching and strengthening exercises.
• Manage Underlying Conditions: Proper control of diabetes and thyroid disorders.
• Avoid Prolonged Immobilization: Early movement post-injury or surgery can prevent stiffness.

If you experience persistent shoulder pain or stiffness, consult a healthcare professional to confirm the diagnosis and explore appropriate treatment.