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Consult our MOH-accredited frozen shoulder specialist for an accurate diagnosis & personalised treatment plan.
Frozen Shoulder Specialist In Singapore
Frozen shoulder, medically known as adhesive capsulitis, is a condition characterised by stiffness and pain in the shoulder joint. This condition typically develops gradually, worsening over time and eventually improving, usually over a span of one to three years. The precise cause of a frozen shoulder is not completely understood, but it involves the thickening and tightening of the shoulder capsule, leading to restricted movement.
Are your symptoms of frozen shoulder affecting your quality of life? Consult our frozen shoulder specialist for an accurate diagnosis & personalised treatment plan.
Dr Dennis Ng Zhaowen
Symptoms of Frozen Shoulder
The symptoms of a frozen shoulder develop gradually and worsen over time, typically following three distinct stages:
Freezing Stage
- Pain in the Shoulder: The initial symptom is a dull or aching pain in the shoulder. This pain is often more pronounced at night, disrupting sleep.
- Gradual Loss of Shoulder Motion: As the pain increases, the range of motion in the shoulder begins to decrease. Activities such as lifting the arm or reaching behind become challenging.
- Increased Pain with Movement: Any attempt to move the shoulder exacerbates the pain, leading to a protective restriction of movement.
Frozen Stage
- Pain May Begin to Diminish: Although the pain may start to lessen during this stage, it does not disappear entirely.
- Shoulder Becomes Stiffer: The shoulder joint becomes increasingly stiff, making it difficult to perform even simple tasks.
- Range of Motion Significantly Reduced: The limited mobility of the shoulder joint becomes more apparent, severely restricting daily activities.
- Difficulty Performing Daily Activities: Common tasks, such as dressing, reaching overhead, or even combing hair, become arduous due to stiffness and reduced range of motion.
Thawing Stage
- Gradual Improvement in Range of Motion: During this final stage, the range of motion in the shoulder slowly begins to improve.
- Pain Continues to Decrease: The pain continues to diminish, allowing for more comfortable movement.
- Return to Normal Shoulder Function Over Time: With consistent physical therapy and exercises, shoulder function gradually returns to normal, although full recovery can take several months to a few years.
Causes of Frozen Shoulder
The exact cause of frozen shoulder, or adhesive capsulitis, is not well understood, but several factors may contribute to its development:
Shoulder Immobilization
- Due to Injury: Immobilization of the shoulder after an injury, such as a fracture or rotator cuff tear, can lead to the development of a frozen shoulder. The lack of movement can result in stiffness and reduced range of motion.
- Post-Surgery: After shoulder surgery, limited movement during the recovery period can increase the risk of developing a frozen shoulder. Adhering to prescribed physical therapy exercises is important to prevent this condition.
- Other Conditions: Conditions that limit shoulder movement, such as a stroke or prolonged bed rest, can also contribute to the development of a frozen shoulder.
Inflammatory Processes
- Joint Inflammation: Inflammation within the shoulder joint can lead to swelling and pain, restricting movement and potentially causing a frozen shoulder. Conditions like tendinitis or bursitis may be precursors.
- Systemic Inflammation: Autoimmune diseases or systemic inflammatory conditions, such as rheumatoid arthritis, can also play a role in the development of a frozen shoulder.
Scar Tissue Formation
- Within the Shoulder Capsule: The formation of scar tissue (adhesions) within the shoulder capsule can restrict movement and cause stiffness. This process often occurs without a clear triggering event.
- Fibrosis: Over time, the shoulder capsule can become thickened and contracted, a process known as fibrosis, leading to significant limitations in the range of motion.
Diagnosis of Frozen Shoulder
Diagnosis of a frozen shoulder involves a combination of medical history, physical examination, and imaging tests to accurately identify the condition and rule out other potential causes of shoulder pain and stiffness.
Medical History
- Review of Symptoms and Duration: A detailed discussion with the patient about the onset, duration, and progression of symptoms, including pain and stiffness, helps in identifying the stage of a frozen shoulder.
- Assessment of Risk Factors and Underlying Conditions: Evaluating the patient’s medical history for risk factors such as diabetes, thyroid disorders, previous shoulder injuries, or surgeries is important for a comprehensive diagnosis.
Physical Examination
- Evaluation of Shoulder Range of Motion: The doctor will assess both active (performed by the patient) and passive (performed by the doctor) range of motion to determine the extent of shoulder stiffness and pain.
- Palpation to Assess Pain and Stiffness: Palpating the shoulder joint and surrounding muscles helps in identifying areas of tenderness and the degree of stiffness.
- Assessment of Active and Passive Range of Motion: Comparing the patient’s ability to move the shoulder independently versus the range of motion when assisted by the doctor provides insight into the severity of the condition.
Imaging Tests
- MRI or Ultrasound: These imaging techniques provide detailed views of the soft tissues in the shoulder, including the shoulder capsule and surrounding structures, helping to identify inflammation, scar tissue, or other abnormalities.
- Arthrogram: This imaging test involves injecting a contrast dye into the shoulder joint before taking X-ray or MRI images. The dye outlines the structures within the joint, providing detailed images that help in diagnosing a frozen shoulder and assessing the extent of joint capsule involvement.
Treatment Options for Frozen Shoulder
Treatment for a frozen shoulder focuses on pain relief and restoring shoulder motion. A combination of non-surgical and surgical treatments may be utilised based on the severity and progression of the condition.
Non-Surgical Treatments
- Physical Therapy: Physical therapy is important for managing a frozen shoulder. Range of motion exercises help improve flexibility and restore shoulder movement, tailored to individual needs. Strengthening exercises build muscle strength around the shoulder, supporting joint stability and preventing further stiffness. Regular sessions, often involving multiple weekly appointments, are essential for gradual improvement in shoulder function.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or naproxen, provide pain relief and reduce inflammation, making it easier to engage in daily activities and physical therapy. These medications should be taken regularly as advised by a doctor to manage symptoms effectively, with careful adherence to dosage instructions to avoid potential side effects.
- Corticosteroid Injections: Corticosteroid injections directly into the shoulder joint can significantly reduce inflammation and pain, particularly useful in the initial painful phase of a frozen shoulder. These injections offer temporary relief, allowing patients to participate more effectively in physical therapy exercises.
- Heat or Cold Therapy: Heat therapy relaxes muscles and improves blood flow, which can be beneficial during the stiff phase of a frozen shoulder, while cold therapy reduces swelling and numbs sharp pain, often used in the painful phase. These methods are frequently used in combination to maximise relief. Heat or cold therapy can be easily performed at home using heating pads, warm towels, ice packs, or cold compresses, providing a simple yet effective way to manage pain and stiffness between physical therapy sessions.
Surgical Treatments
- Manipulation Under Anaesthesia: This procedure involves forcefully moving the shoulder while the patient is under general anaesthesia. The aim is to loosen the tight joint capsule by breaking up adhesions, which can significantly improve shoulder mobility and reduce pain.
- Arthroscopic Surgery: In this minimally invasive surgery, tiny incisions are made, and a small camera, called an arthroscope, is used to guide surgical instruments. The surgeon releases the tight shoulder capsule, which helps restore a greater range of motion. This procedure is often preferred due to its smaller incisions and quicker recovery times.
- Capsular Release: During this surgical procedure, specific cuts are made in the tight shoulder capsule to release it. This targeted approach helps restore shoulder movement significantly, providing relief from the stiffness and pain associated with a frozen shoulder.
When to Seek Medical Attention
Seek medical attention if you experience:
- Severe Shoulder Pain: Pain that interferes with daily activities, making it difficult to carry out normal tasks.
- Significant Loss of Shoulder Motion: Noticeable reduction in the ability to move the shoulder, which may affect your range of motion.
- Persistent Symptoms: Symptoms that persist beyond a few weeks without improvement, indicating that the condition may not resolve on its own.
- Inability to Sleep: Difficulty sleeping due to shoulder pain, which can affect your overall health and well-being.
- Difficulty Performing Daily Tasks: Challenges in dressing, grooming, or reaching overhead, indicating that the shoulder issue is significantly impacting your daily life.
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #08-41
Singapore 329563
Monday – Friday: 9am – 1pm; 2pm – 5pm
Saturday: 9am – 1pm
Sunday & PH: CLOSED
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Gleneagles Medical Center
6 Napier Road #07-15
Singapore 258499
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Frequently Asked Questions (FAQs)
Can Frozen Shoulder Recur?
Recurrence of frozen shoulder in the same shoulder is uncommon once the condition has fully resolved. However, it is possible for a frozen shoulder to develop in the opposite shoulder. The risk of recurrence or occurrence in the other shoulder can be influenced by several factors, including underlying health conditions such as diabetes, thyroid disorders, and cardiovascular diseases. Maintaining regular shoulder mobility exercises and managing underlying health conditions can help reduce the risk of recurrence. It is important for patients who have experienced a frozen shoulder to remain vigilant and seek early intervention if symptoms begin to develop in the opposite shoulder.
Can Frozen Shoulder Be Prevented?
While it may not be possible to prevent a frozen shoulder entirely, especially if you have underlying health conditions, there are steps you can take to reduce your risk. These include maintaining shoulder mobility through regular exercise, managing any underlying medical conditions effectively, and avoiding prolonged periods of shoulder immobilisation. If you need to immobilise your shoulder due to an injury or surgery, work with your doctor to start gentle range-of-motion exercises as soon as it is safe to do so.
Is Surgery Always Necessary for Frozen Shoulder?
No, surgery is not always necessary for a frozen shoulder. Many patients respond well to non-surgical treatments such as physical therapy, NSAIDs, corticosteroid injections, and joint distension. Surgery is typically considered only when non-surgical treatments have failed to provide adequate relief and the patient continues to experience significant pain and limited mobility. Surgical options, such as manipulation under anaesthesia or capsular release, aim to restore shoulder mobility and reduce pain.
What Should I Do If I Suspect I Have a Frozen Shoulder?
If you suspect you have a frozen shoulder, it is essential to seek medical attention promptly. Early diagnosis and intervention can prevent the condition from worsening and help you regain shoulder mobility more quickly. Your doctor will conduct a thorough evaluation, which may include a medical history review, physical examination, and imaging tests. Based on the diagnosis, a tailored treatment plan will be developed to address your specific needs. Following your doctor’s recommendations and adhering to the treatment plan is important for a successful recovery.