Frozen shoulder: what it is and what causes it

By Cristiano Antonino Last updated Jun 18, 2023

Frozen shoulder is a term commonly used to indicate adhesive capsulitis of the shoulder: it is a very painful inflammatory pathology that progressively restricts the movement of this joint, up to total immobility

The first signs of the pathology are continuous and intense pain in the shoulder, particularly during the night, making it impossible to find a comfortable position to sleep.

Then, gradually, the natural movements of the joint become more and more complex, until it is no longer possible to move the shoulder.

Women between the ages of 35 and 55 are most affected, but it is possible for anyone to suffer from it.

Due to the lack of specificity of the symptoms – which can be attributed to neck stiffness or general localised inflammation – frozen shoulder is often diagnosed very late, causing the problem to worsen and lengthening recovery times.

What is frozen shoulder

Adhesive capsulitis, frozen shoulder syndrome or frozen shoulder are all terms that refer to the same medical condition, i.e. an inflammatory and painful condition of this joint that progressively reduces its movement.

Responsible for the pathology is a structure that is part of the joint, namely the capsule.

Its function is to encase the joint to help stabilise it.

It can happen that, due to inflammation, the capsule becomes increasingly stiff and, progressively, the patient loses mobility in the shoulder.

Joint limitation affects both active and passive movements, in other words both when the affected person voluntarily wants to move the shoulder and when another person, such as the doctor or physiotherapist, does it.

It is precisely the passive restriction of movement that is one of the distinguishing features of the disease, which sets it apart from other conditions, such as rotator cuff injury.

This particular syndrome develops in three stages

Inflammation that causes severe pain. In this phase it is easy for the disease to be confused with other types of inflammation or injury. This phase usually lasts 3-4 months.
Stiffness. As the shoulder stiffens, the pain decreases. It can happen – in severe cases – that the numbness and blockage of movement also reaches the hand. This phase lasts approximately 4-6 months.
Thawing or recovery phase, when – through targeted therapies and treatment – the shoulder gradually regains mobility. This phase is quite long and can last from one to three years.

What are the symptoms?

As we have mentioned, this syndrome has some general symptoms and some peculiar ones, which, already from the first clinical test, can point the specialist towards a diagnosis.

Obviously, the most important symptom to consider is the limitation of movement, which progressively degenerates, associated with pain.

Before the joint stiffens, however, there are alarm bells that can help us reach an early diagnosis.

As we have seen, many symptoms are common to other pathologies, which is why it is essential to consult a specialist immediately in order to prevent the situation from worsening irreversibly or to rule out the presence of other pathological conditions that require prompt treatment.

Frozen shoulder initially presents with intense pain that is often associated with localised swelling, often in the upper external part of the shoulder

The discomfort is aggravated during the night, usually affects the non-dominant limb and prevents habitual actions such as combing or shaving.

What are the causes

The cause of the condition, as we have seen, is inflammation resulting in stiffening of the capsule, i.e. the connective tissue that helps regulate the movements of the joint.

It is often not possible to establish the cause of the condition with certainty, although studies have shown that diabetic patients have a higher risk of developing frozen shoulder.

Those suffering from autoimmune diseases, hypercholesterolaemia and Parkinson’s disease are also more prone to contract the disease.

Injuries or previous surgery may also have an influence: following forced immobilisation – which is not followed by proper rehabilitation – it is possible to develop adhesive capsulitis of the shoulder.

Another predisposing factor could be the prolonged use of certain medications.

Although there are reasonable suspicions, in most cases, frozen shoulder arises without apparent cause.

Diagnosis

A specialist should be consulted for a correct diagnosis.

Due to the peculiarity of the symptoms, a diagnosis can be made, with reasonable certainty, already after the first examination: through the anamnesis the doctor will obtain the necessary data, paying particular attention to any symptoms that can be traced back to adhesive capsulitis.

From here he will move on to the objective examination, during which he will conduct a series of tests aimed at checking the mobility of the shoulder joint, thus ruling out the possibility of a cuff tendon injury.

In this way, the orthopaedist will suspect the diagnosis, which can be confirmed with a diagnostic imaging test, usually an X-ray.

He will hardly prescribe an MRI or CT scan, which are more useful for detecting other types of injuries, such as tendon injuries.

Through the X-ray it will be possible, on the other hand, to rule out arthrosis, arthritis and calcifications of various kinds, thus excluding other possible causes of this symptomatology.

Blood tests may be recommended to assess the presence of predisposing factors such as diabetes, hypercholesterolaemia or thyroid dysfunction.

Possible treatments for frozen shoulder

Since the causes leading to the onset of the condition are often unknown, the associated treatments are also often complicated.

It is possible for the pathology to resolve itself.

To shorten the course, however, it is advisable to undertake a course of physiotherapeutic rehabilitation. In any case, the pathology is curable.

Treatments will differ depending on the phase of the disease: in the first phase, treatment will aim to reduce pain and inflammation, in the other two phases, work will be done to regain mobility of the joint and strengthen the muscles.

As mentioned above, recovery times are quite long, also because intervention is generally only carried out when the shoulder is completely blocked, i.e. when the pathology has already progressed.

Let’s take a closer look at how one intervenes depending on the moment of diagnosis:

In the first phase one must aim to extinguish the inflammation. An anti-inflammatory therapy will be prescribed, which may involve the use of oral corticosteroids but also local infiltrations of cortisone or hyaluronic acid. In order to better cope with the pain, it is possible to take analgesics that help, in particular, during physiotherapy sessions. During this phase, in fact, it is essential to continue to move the shoulder as much as possible with respect to the pain, so as not to further stiffen the joint. However, a brace may be prescribed to be worn at certain times of the day in order to better cope with the pain. During the physiotherapy session, the specialist may opt for massage therapy, manual therapies for stretching the muscles and mobilising the shoulder, exercises that help joint mobility to be carried out in water, or certain exercises to be done at home independently. These are stretching and mobilisation exercises, so as to be able to improve shoulder mobility and reduce the loss of muscle tone. It is possible that the first benefits will already be felt within a few weeks. To counteract the blockage, hot packs may also be recommended; local vasodilatation – particularly before the stretching exercises – is particularly helpful in ‘loosening up’ the joints.
In the second and third phase, physiotherapeutic rehabilitation will be crucial. In addition to massage therapies and manipulations, treatments with ultrasound, laser therapy, and tens, which aid recovery, may also be useful. Improvements will not be immediate, it will take time – months, or even years – before one can return to a normal situation.

Obviously, in addition to following specific therapeutic courses, it is good to pay attention to daily actions to avoid worsening the situation.

During the entire rehabilitation process, in fact, one must absolutely avoid abrupt movements or lifting heavy loads with the painful arm.

Sometimes the frozen shoulder takes on psychosomatic characteristics, which is why it is essential to approach the therapy in an optimistic manner: you may not notice the hoped-for results right away, but you will have to maintain a certain constancy in order to recover as quickly and as well as possible.

If these paths do not work and the patient’s quality of life is compromised, arthroscopic surgery will be considered.

The need for surgery, however, is a very rare occurrence, so only a small percentage of cases will undergo surgery.

Lately, many people are choosing to follow alternative and complementary paths, turning to specialists and undergoing osteopathic manoeuvres and acupuncture: although there are no studies proving the effectiveness of these methods, they manage to bring considerable benefits without the risk of side effects.

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