Shoulder pain so bad that you cannot move, cannot lift the arm, or find it difficult to put on a shirt? These may be signs of "frozen shoulder," which many people overlook — but which, left alone, may greatly affect quality of life. This article will take you through frozen shoulder in detail, from the symptoms and the causes to the shoulder exercises you can do at home, as well as modern treatment from a team of specialist physicians.
What is frozen shoulder?
Frozen shoulder is a condition in which the shoulder joint becomes inflamed and scar tissue forms in the joint capsule, so that movement decreases and there is pain. The patient feels as though the shoulder has been "frozen," which is where the name comes from.
Our shoulder joint is wrapped in a joint capsule that is elastic. When inflammation occurs, the capsule thickens and forms scar tissue, so that it contracts and stiffens, and the movement of the shoulder joint becomes limited — like a large shirt shrinking until it can no longer be worn.
The symptoms of frozen shoulder at each stage (freezing, frozen, thawing)
Frozen shoulder develops through 3 stages:
- The first is the freezing stage, with a great deal of pain and decreasing movement, lasting 2-9 months
- The second is the frozen stage, when the pain decreases but stiffness is severe, lasting 4-12 months
- The last is the thawing stage, when movement gradually improves, taking 1-3 years
Check now! The 10 symptoms of frozen shoulder that are warning signs
Noticing the symptoms early makes treatment more effective. The main symptoms of frozen shoulder take several forms that patients should know.
1. Shoulder pain at night
One of the symptoms most often found is shoulder pain at night, bad enough to prevent sleep. The pain usually occurs when changing position or lying on the affected shoulder, so the patient has to lie on one side only, or on their back all the time.
2. Not being able to move or lift the arm fully
Lifting the arm upward or to the side, or rotating it, is limited, as though something were preventing full movement. The patient may be able to lift the arm only 90 degrees, instead of the usual 180 degrees.
3. Difficulty reaching behind the back
Daily activities such as fastening a bra or putting on a shirt become difficult, because the hand cannot reach behind the body. This is usually a clear sign of frozen shoulder.
4. Difficulty putting on or taking off a shirt
A basic routine such as dressing becomes hard. The patient usually has to use the good arm to help put on a shirt, or may have to choose a shirt that opens at the front instead of one that goes over the head.
5. Not being able to lie on the painful side
Lying on the affected shoulder produces severe pain, so the patient has to find a comfortable position and may need a pillow for support to reduce the pressure. This usually affects the quality of sleep.
6. A stiff arm in the morning
Patients often find that on waking in the morning the affected arm is very stiff, moves less than usual, and takes a while to "loosen" before it can move better.
7. Pain spreading into the arm and neck
The pain from the shoulder may spread to the upper arm, neck, and upper back, producing tightness and discomfort over a wide area, not only around the shoulder joint.
8. Not being able to reach things placed high
Taking things from a high shelf, such as from a wardrobe or a rack, becomes difficult, because the arm cannot be lifted high. The patient usually has to use a chair or steps.
9. Difficulty driving (not being able to turn the wheel fully)
Driving may be a problem, particularly turning the wheel, reversing, or holding the wheel in different positions, which makes travel inconvenient and may be unsafe.
10. Difficulty washing the hair or bathing
Activities in the bathroom, such as washing the hair, scrubbing the back, or bathing, become a challenge, because they need the shoulder joint to move in several directions. The patient may have to ask for help from someone in the family.
What can cause frozen shoulder?
Understanding the causes of frozen shoulder helps in preventing and treating it precisely. The causes can be divided into several kinds.
Not moving the shoulder joint for a long time
The main cause most often found is the shoulder joint not moving for a long time, for example after an injury, an operation, or being in a cast. When the shoulder joint is not used regularly, the capsule contracts and stiffens. In addition, it is now also found that office syndrome, or working in an office for long periods in the same position, is an important cause of inflammation and tightness in the muscles around the shoulder joint, which, left for a long time, may lead to frozen shoulder — particularly in those who sit working at a computer and do not exercise the shoulder joint regularly.
Accidents and injury
Injury from an accident, a fall, or overuse of the shoulder joint may cause inflammation and lead to frozen shoulder, particularly an injury that requires the shoulder to be rested for a long time.
Related chronic conditions
Patients with diabetes, thyroid disease, heart disease, or Parkinson's disease are at higher risk of frozen shoulder than the general population, because these conditions affect blood flow and the working of tissue.
Who is at risk of frozen shoulder?
Knowing the risk groups helps in preventing it and caring for yourself appropriately.
Older adults (aged 40-60)
Frozen shoulder is most often found between the ages of 40-60, because the tissue begins to degenerate and blood flow decreases, so that the joint capsule becomes less elastic and more at risk of inflammation.
Patients after surgery, or those who have to wear an arm cast
Having the shoulder joint held still for a long time after surgery or treatment in a cast increases the risk of frozen shoulder. Physiotherapy after treatment is therefore very important.
Patients with chronic disease
Patients with chronic conditions such as diabetes, high blood pressure, heart disease, or chronic kidney disease are at higher risk of frozen shoulder than others, because these conditions affect circulation and tissue repair.
Approaches to treating frozen shoulder
Treating frozen shoulder requires a variety of approaches, used continuously, for the best result.
Treatment with new technology and innovation
Modern technologies such as Focused Shockwave Therapy and Peripheral Magnetic Stimulation (PMS) help stimulate tissue repair and reduce inflammation effectively. There is also Western-style needling, dry needling, and High Power Laser Therapy, which help release muscle tightness and speed recovery. For patients with severe symptoms that do not respond to older treatment, there is also the technique of capsule dilatation, or hydrodissection, a method of injecting fluid to separate the fascia and the joint capsule that have contracted and stuck together in the shoulder joint. This treatment helps expand the space within the shoulder joint, reduce pressure and inflammation, and allow the patient to move much better quickly, without surgery, with a high success rate in treating severe frozen shoulder.
Basic self-treatment at home
Alternating hot and cold packs, resting enough, and avoiding movements that cause too much pain are basic ways of easing the symptoms. However, self-treatment alone may not be enough.
5 simple exercises to beat frozen shoulder
- Wall crawling — stand side-on to a wall and walk the fingers up it as far as they go, holding for 15 seconds
- Shoulder circles — place the hand on the opposite shoulder and circle the elbow slowly, 10 rounds
- Behind-the-back stretch — put the affected hand behind the back and use the other hand to draw the elbow gently
- Stick exercise — use a stick or a towel, hold both ends, and stretch the shoulder joint in different directions
- Arm swings — lean forward, let the arm hang down, and swing it gently back and forth
Medication
Painkillers and anti-inflammatory medicines such as NSAIDs can help reduce pain and inflammation in the short term. Topical medicines are also effective in reducing pain at a specific point, but should not be used as the main treatment on their own.
Steroid injection into the shoulder joint
Where the symptoms are severe, the doctor may consider injecting a steroid into the shoulder joint to reduce inflammation and pain. This method is highly effective in the short term, but must be carried out by a specialist physician only.
Surgery (when other treatment does not work)
If non-surgical treatment has not worked over a long period, the doctor may consider surgery to release the contracted joint capsule. This is a last option and requires intensive physiotherapy afterwards.
Summary
Frozen shoulder is a condition that can be treated with correct and continuous care. Noticing the symptoms early and consulting a specialist physician makes the treatment more effective. At PYONG Rehabilitation Clinic we have modern technology and a team of specialist physicians in rehabilitation medicine ready to help you restore the use of the shoulder joint to normal. If you have symptoms you are unsure about, you should consult a doctor soon, for effective treatment and to prevent the condition from worsening.
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