Frozen Shoulder - Changi General Hospital

Sports Medicine
Frozen
Shoulder
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Frozen Shoulder
What is frozen shoulder?
This is a condition in which the capsule of the shoulder joint becomes inflammed and
thickened. This results in pain, stiffness and restriction of shoulder movement. This condition
is also known as adhesive capsulitis. It is more common in women between the ages of
40–65 years.
clavicle
shoulder
capsule
inflammed
capsule
scapula
humerus
Normal right shoulder (front view)
Frozen right shoulder (front view)
What are the symptoms?
You may have frozen shoulder if you experience pain and stiffness when:
1. Lifting your arm, either straight out in front or sideways.
2. Rotating your arm, such as when unzipping the back of your dress or reaching for objects
in your rear pocket.
3. Shampooing and dressing.
4. Sleeping on the affected shoulder.
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What causes frozen shoulder?
The exact cause is unknown. The condition has been linked to auto-antibodies that attack
the joint capsule, resulting in inflammation, adhesion and eventual scar tissue formation. It
may be triggered by injury (including surgery), degenerative changes in the joint, as well
as viral illnesses. This condition is also more common in diabetics. Your shoulder may go
through several stages as the scar tissue forms, with each stage lasting between three to six
months:
1. Freezing stage—you may experience ache and mild stiffness as the disease starts. Pain
worsens as the condition progresses.
2. Frozen stage—pain diminishes but stiffness increases. Shoulder movements can be
severely restricted.
3. Thawing stage—shoulder movement improves, and you will be able to do more
activities. Complete resolution is the norm but up to 15% of patients may have remaining
movement restriction or weakness.
What will my doctor do?
After a physical examination, an ultrasound scan and X-ray may be required to exclude
other causes of pain. In the early stages, it may be difficult to tell it apart from other painful
conditions affecting the shoulder.
How is it treated?
The disease will, unfortunately, have to run its course. The goal of treatment is to minimise
pain and discomfort during the disease process and to restore full range of motion and
strength by the end of its natural course. Your doctor may prescribe a course of antiinflammatory
medication for symptom relief. Forceful manipulation should be avoided as
this may worsen symptoms. Hydrodilatation of the joint may be required in severe cases.
During this procedure, which is carried out under local anaesthesia, a small volume of sterile
solution is injected into the joint to loosen the adhesions.
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To maintain shoulder function, you are encouraged to perform the exercises shown. Each
exercise should be performed at least twice a day. Application of a warm towel for 5–10
minutes prior to exercise will reduce the discomfort. Exercise both shoulders, so that you can
also maintain movement in the healthy shoulder. If there is increased pain after exercise, ice
the painful part for 5-10 minutes.
Range of motion (ROM) exercises
Assisted Abduction
Assisted
internal rotation
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Assisted
forward flexion
Scapular retraction
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Stretches
Cervical, chest & shoulder stretch
Posterior Capsule Stretch
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What is my prognosis?
Many people with frozen shoulder regain full use of their shoulder after the condition has
run its course. However, this may take 6–18 months from the onset of symptoms, and there
may be some remaining pain and stiffness. Recurrence, either in the same shoulder or the
other side can happen.
The Changi Sports Medicine Centre (CSMC) is the largest multi-disciplinary
Sports Medicine centre in Singapore. Our Sports Physicians, Sports Orthopaedic
Surgeons, Sports Physiotherapists, Exercise Physiologist, Sports Trainers, Dietitians,
and Podiatrists cater to both recreational and competitive athletes. CSMC’s services
include the treatment of sports injuries, injury prevention, pre-participation
screening, performance enhancement, exercise testing, exercise prescription, weight
management, and sports event medical coverage.
The Singapore Sports Medicine Centre (SSMC) is an alliance between the Changi General Hospital
and the Singapore Medical Group. Conveniently located at Novena Medical Centre, SSMC is a
one-stop private clinic for the management and treatment of sports injuties. Providing the same
services as CSMC, SSMC is led by its Medical Director, Dr Ben Tan, who is also Head and Senior
Consultant Sports Physician at CSMC.
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For appointments and enquiries,
please call the CGH Appointment Centre at
Tel: (65) 6850 3333
CGH Appointment Centre operating hours:
8.30 am to 8.00 pm (Monday to Friday)
8.30 am to 12.30 pm (Saturday & Sunday)
Closed on Public Holidays
For more information, please visit
http://www.cgh.com.sg
2 Simei Street 3 Singapore 529889
Tel: 6788 8833 Fax: 6788 0933 www.cgh.com.sg
Reg No 198904226R
F
S
All information is valid at the time of printing (September 2009)
and subject to revision without prior notice.
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