Do You Have Frozen Shoulder?

When Katja Edler noticed tightness around her right shoulder in the summer of 2017, she assumed she’d been spending too much time at her desk. A 44-year-old book editor who lives in Ehningen, Germany, Edler was in Dubai for her husband’s job and working from home. About three months later, her symptoms worsened: “I got up one morning in a lot of pain and couldn't lift my arm.” Edler met with an orthopaedist, who took an X-ray and then identified the problem: She had frozen shoulder.

Also called adhesive capsulitis, the condition affects up to five per cent of people and occurs when the connective tissue surrounding the shoulder joint capsule becomes inflamed. Overtime, this tissue thickens and stiffens,causing pain and restricted movement. Eventually, even without treatment, the soft tissue will heal. But recovery can take one to three years—or more. “That’s a long time to live with something so disabling,” says Dr Amar Rangan, a shoulder surgeon at James Cook University Hospital in Middlesbrough, UK.

Early treatment improves the symptoms faster, but identifying the condition can be a challenge, since symptoms mimic issues like arthritis and rotary cuff injuries. Another mystery is why it develops. It’s more likely if your shoulder has been immobile—because of a broken arm, or a stroke,say—or after a jarring fall. But in most cases, the problem seems to come out of nowhere. Women are four times more likely to have frozen shoulder and people with diabetes,thyroid disease, heart disease or autoimmune conditions are at higher risk.

“It’s surprisingly common in people in their 40s to 60s, and prevalent in people over the age of 60,” says Karen McCreesh, a physiotherapist and researcher in Limerick, Ireland. She says patients typically describe the discomfort as “burning” and often worse at night.

While it’s rare to have a recurrence in the same shoulder, about 10 to 15per cent of patients will develop it on the other side, according to Rangan.

Steroid injections or medications like ibuprofen can reduce pain and inflammation, and physiotherapy is often effective for regaining range of motion. While the latter is less invasive and risky than surgical options, Rangan recently co-leda trial showing that both physiotherapy and surgery help significantly with recovery. His team is also conducting research into the inflammatory changes, in the hopes of treating the underlying cause.

A 2021 review of studies demonstrated that exercise helps with healing. It can involve the shoulder if the person can tolerate it, although whole-body exercise pays off, too.“Some patients develop a big fear of movement,” says McCreesh, “but very painful exercise isn’t necessary to see benefits.” For example, exercising in a warm pool may feel more soothing.

Edler opted for physiotherapy,going to appointments for six months and doing prescribed exercises at home. “With each session, I regained some movement range and had less discomfort,” she says. Today, more than four years after developing issues, she has 90 per cent function in her shoulder and is pain-free.

There remains no known way to prevent the condition, which is why an early diagnosis is so important.Rangan suggests “taking your shoulders through a range of movement every day to make sure they done tighten up. If you notice anything,seek help.”