What to do when your body gives you the cold shoulder

Published on 23 December 2022

About 5% of the population suffer from frozen shoulders – but what exactly is it? And how do you go about treating the condition?

It is an ailment that can cause immense pain and discomfort, and may even affect your mental and emotional well-being.

But despite its potential severity, there is often no identifiable trigger for the condition known as frozen shoulder, which is estimated to affect up to 5% of the population. 

This means that frozen shoulders can sneak up on anyone at any time, although it is more common in women than men, and often strikes those between the ages of 40 and 60.

So, what exactly is frozen shoulder?

The 3 stages of frozen shoulder

Frozen shoulder, also known as 'adhesive capsulitis', is an inflammatory condition in which the ligaments and capsule of the shoulder joint become inflamed, thickened, and contracted. The bones and tendons, however, are usually unaffected – as such, radiographs of a frozen shoulder will generally appear normal.

According to Adj Asst Prof Kevin Yik, Consultant, Department of Orthopaedic Surgery, Ng Teng Fong General Hospital (NTFGH), there are three stages to the condition: Freezing, Frozen, and Thawing.

Each stage lasts for around six to nine months on average, with the entire recovery process sometimes lasting up to three years.

The early signs of frozen shoulder, however, may be innocuous. It could start with mild pain and stiffness around the shoulder that – while uncomfortable – is not intolerable, and so, is often ignored.

Over time, however, the pain intensifies, while the stiffness progressively worsens.

This period, known as the ‘Freezing Stage’, is usually the hardest to endure, and can cause great distress and inconvenience for those affected.

“The pain can cause sleep deprivation, and even cause anxiety in some patients,” said Dr Yik.

“The stiffness affects shoulder movements in multiple directions. This restriction in range of shoulder movements causes difficulty with daily activities, such as dressing, bathing and household chores. Putting on a shirt and hair washing can be a challenge for patients with frozen shoulders. Female patients often cite difficulty with bra wearing as they are unable to reach behind their backs.”

During the ‘Frozen Stage’, the pain in the patient’s shoulder begins to gradually lessen, although the stiffness may worsen, or remain unchanged.

As its name suggests, the ‘Thawing Stage’ – which is the final part of the recovery process – sees the stiffness in the shoulder improve, often resolving completely. This stage is also usually painless.

Diagnosing a frozen shoulder

Given that for most parts, the cause of frozen shoulders is not apparent and does not show up in radiographs, the condition can be tricky to diagnose.

To do so, doctors will have to take a detailed history of the patient, as well as perform a clinical examination of their shoulder.

This examination often involves checking the range of motion in the patient’s shoulder, as Dr Yik explained, “Frozen shoulder usually causes restriction in both active and passive range of shoulder movements. This means that the range of shoulder movements is similarly bad when patients move their arm with or without assistance. 

“Oftentimes, patients with frozen shoulders also have more difficulty with internal rotation (reaching their back) than with abduction (raising their arms overhead).”

Patients who previously injured their shoulders, or have certain underlying health issues, are also more susceptible to developing the condition.

Dr Yik added, “Frozen shoulder can be classified either as primary (idiopathic) or secondary. There is no identifiable cause for the former, while secondary frozen shoulder occurs after a shoulder injury (post-traumatic), or shoulder surgery (post-operative).

“Patients with diabetes, thyroid and adrenal problems are also at higher risk of developing frozen shoulders because of disturbances in the endocrine system. These patients often also have a more prolonged course of recovery.”

Thawing a frozen shoulder

While the road to recovery from a frozen shoulder may take a few years, the good news is that it does not usually require patients to go under the knife.

“The vast majority of frozen shoulder patients are successfully treated without surgery, and are often able to regain full, painless shoulder function,” Dr Yik shared. “Non-operative treatment commonly includes analgesia (including anti-inflammatory medications), steroid injections, as well as physiotherapy (both supervised and self-directed) and rehabilitation exercises.

“Steroid injections can provide fast, effective pain relief. This can be easily done in the outpatient clinic, taking no more than 10 minutes to perform, with or without the aid of ultrasonography. 

“Other non-operative treatment methods include joint distention (by injecting the shoulder joint with saline or steroids) and nerve block injections. These are usually considered when analgesia, physiotherapy and steroid injections fail to relieve symptoms adequately.”

There are, however, instances where surgery is required to resolve the issue.

“A small number of patients with frozen shoulders may require operative treatment,” Dr Yik elaborated. “These are typically patients whose shoulder pain and stiffness fail to improve despite at least six months of non-operative treatment. Operative treatment usually involves manipulation under anaesthesia, and keyhole surgery to release the thickened joint capsule and ligaments.”

Physical therapy can be very beneficial in the treatment of a frozen shoulder, and will go a long way to helping you restore movement and range of motion. Ms Kellyn Lee Jia Lin, Senior Physiotherapist, NTFGH, demonstrates some of the exercises that you can do to help thaw a frozen shoulder.

Exercise 1

• Hold your affected arm with the other hand.
• Lean forward and use your unaffected hand to move your injured arm in a circular motion.
• Do it for 10 - 15 reps, then change direction. Perform this exercise 3 times a day.

Exercise 2

• Use your unaffected arm to support your elbow
• Bring your affected arm up within a painful tolerance
• Bring it down slowly
• Do this for 10 reps, 3 times a day

Exercise 3

• Hold your injured arm as seen in the video
• Use your unaffected arm to cradle the injured arm to the side
• Bring it back to original position
• Do this for 10 reps, 3 times a day
  

Exercise 4

• Put both hands on a table as seen in the video
• Slide your hands forward, while moving your body in the same direction
• Slide your hands back to the starting position
• Do this for 10 reps, 3 times a day

Exercise 5

• Turn your body to the side, and put your affected arm on a table
• Slide your affected arm to the side. Ensure there is no increase in pain.
• Slide your arm back to the starting positiong.
• Do this for 10 reps, 3 times a day

Exercise 6

• Grab a light bamboo stick or something similar, like an umbrella
• Hold the stick as seen in the video, with your arms beside your body
• Use the unaffected arm to push the stick towards the injured arm
• Slowly pull the stick back to the starting position
• Ensure your body is straight and does not turn throughout this exercise
• Do this for 10 reps, 3 times a day

Exercise 7

Exercise 8

• Use your injured arm to hold the shoulder of the unaffected arm
• Use your unaffected arm to push the elbow of the injured arm to the back till you feel a stretch
• Hold for 10 seconds
• Release the hold and return to starting position
• Do it for 5 reps, 3 times a day

Exercise 9

• Put your injured arm against the wall as seen in the video
• Turn your body away from the wall
• Hold the stretch for 30 seconds
• Do it for 5 reps, 3 times a day

In consultation with Adj Asst Prof Kevin Yik, Consultant, Department of Orthopaedic Surgery, NTFGH and Ms Kellyn Lee Jia Lin, Senior Physiotherapist, NTFGH.