Just like every joint in our body, the shoulder joint is surrounded by a capsule. In a normal shoulder, the capsule is soft and flexible, allowing a wide range of motion. In frozen shoulder syndrome, the capsule becomes inflamed and contracts, reducing the joint's volume. As a result, shoulder movement becomes restricted, and pain occurs.
In the treatment of frozen shoulder, ultrasound-guided cortisone injections and manual therapy combined with physiotherapy yield highly successful results. Some resistant cases of frozen shoulder may require surgical intervention through shoulder arthroscopy.
What is Frozen Shoulder?
Frozen shoulder is characterized by shoulder pain and restricted shoulder movement. It involves an inflammatory process that causes thickening and contraction of the shoulder capsule, ultimately reducing its volume. Additionally, the ligaments embedded in the capsule are affected, becoming thickened and stiff. This further restricts shoulder mobility.
What are the Causes of Frozen Shoulder?
Although the exact cause of frozen shoulder is not fully understood, the following conditions are frequently observed in affected patients:
Hormonal Disorders: Common in diabetic and thyroid patients. It is also more frequent in women during menopause and men with imbalanced testosterone levels.
Shoulder Trauma: Even minor shoulder injuries, which patients may not initially remember, can lead to frozen shoulder. It can also occur after fractures around the shoulder heal.
Cervical Disc Herniation: Many frozen shoulder patients have various cervical spine issues. These can range from mild disc bulges to severe herniations requiring surgery.
After Open-Heart Surgery: Some patients develop frozen shoulder following heart surgery.
Stress: In cases where no other cause is found, patients often report experiencing significant stress recently.
Parkinson's Disease
Heart Disease
What are the Symptoms of Frozen Shoulder?
There are two main symptoms of frozen shoulder: shoulder pain and restricted movement:
Shoulder Pain: It worsens over time, often disrupting sleep. The pain is usually felt in the front and side of the shoulder. Patients often complain about being unable to sleep on the affected shoulder. Over time, the pain can make routine daily activities like brushing teeth, shaving, or combing hair impossible.
Restricted Movement: Initially mild, movement restriction worsens over time. Any attempt to increase movement often intensifies the pain.
Stages of Frozen Shoulder
Frozen shoulder progresses in three stages, with increasing pain and restriction at each stage:
Freezing Stage: In this stage, the shoulder becomes inflamed and painful, often accompanied by nighttime pain. As the capsule tightens, movement becomes increasingly restricted. This stage can last 6 weeks to 9 months.
Frozen Stage: Pain gradually stabilizes, but movement remains restricted. This stage can last from 4 to 12 months.
Thawing Stage: Movement gradually returns to the shoulder. The duration of this stage varies, ranging from 6 to 36 months. Even after recovery, some movement restrictions may persist.
How Long Does it Take to Recover from Frozen Shoulder?
If left untreated, frozen shoulder can take between 1.5 to 3 years to fully recover.
How is Frozen Shoulder Treated?
Frozen Shoulder Injection Therapy:
Ultrasound-guided cortisone injections into the shoulder joint and coracohumeral ligament provide significant relief.
In the first stage of frozen shoulder, physiotherapy combined with injections can stop the disease's progression within 3-4 days.
In stages 2 and 3, multiple injections (2-3 sessions) might be necessary.
Physiotherapy is effective at all stages of frozen shoulder.
Painkillers, especially NSAIDs, can help reduce pain but do not improve range of motion.
Manual therapy by an experienced physiotherapist after joint injections can offer rapid and effective treatment.
Manipulation Under General Anesthesia:
Under general anesthesia in an operating room, careful manipulation helps restore shoulder movement.
Post-procedure, patients are monitored for pain control for several hours.
Joint injections are often administered during this procedure.
Regular physiotherapy following manipulation is crucial for success.
When is Frozen Shoulder Surgery Necessary?
Surgery is considered only when non-surgical treatments fail. However, ultrasound-guided injections have significantly reduced the need for surgical intervention.
How is Frozen Shoulder Surgery Performed?
Frozen shoulder surgery is performed arthroscopically (minimally invasive). Two to three small incisions (1 cm each) are made at the front and back of the shoulder. The tight joint capsule is released to restore movement. Gentle manipulation is often performed simultaneously to maximize range of motion.
A structured physiotherapy program is always a critical part of post-surgery recovery.
Conclusion
Frozen shoulder is a challenging condition characterized by pain and restricted mobility, significantly affecting daily life. Early diagnosis and intervention are key to preventing prolonged symptoms and improving outcomes. Ultrasound-guided cortisone injections, physiotherapy, and in resistant cases, surgical intervention offer effective treatment pathways. A structured recovery plan, including regular physiotherapy, is essential for restoring shoulder function and ensuring long-term relief.
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