Shoulder pain is a common complaint that can arise from various conditions, including frozen shoulder, rotator cuff injuries, and arthritis. If you’re experiencing persistent pain, it’s important to understand the potential causes and seek timely medical attention. This article will explore frozen shoulder, potential causes, when to see a specialist, and what to expect from an orthopaedic consultation. 

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What is Frozen Shoulder? 

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness in the shoulder joint. It results from inflammation and thickening of the shoulder  capsule, leading to restricted movement.  

Natural History of Frozen Shoulder 

Frozen shoulder typically occurs due to inflammation and thickening of the shoulder capsule, leading to stiffness and pain. The condition progresses through three stages: 

• Freezing Stage: Pain increases, especially at night, and shoulder movement becomes more restricted. 
• Frozen Stage: Pain may decrease, but stiffness remains, significantly limiting the shoulder’s range of motion. 
• Thawing Stage: Gradual improvement in mobility occurs, but full recovery can take months or even years. 

Etiology and Risk Factors of Frozen Shoulder 

The exact cause of frozen shoulder is often unknown, but several factors may contribute to its development: 

• Injury or Surgery: Shoulder trauma or post-surgical immobilization can lead to frozen shoulder. 
• Medical Conditions: People with diabetes, thyroid disorders, or heart disease are at higher risk.
• Age and Gender: Frozen shoulder is more common in people between 40 and 60 years of age and tends to affect women more frequently than men. 

When to See a Specialist for Shoulder Pain 

Not all shoulder pain requires immediate medical attention. However, if your pain persists despite taking painkillers for two weeks or more, it’s time to see a specialist. You should also seek evaluation if you experience: 

• Difficulty performing daily activities due to shoulder pain. 
• Significant stiffness or limited range of motion. 
• Weakness in the shoulder. 
• Nighttime pain that interferes with sleep. 

How is Frozen Shoulder Diagnosed? 

An orthopaedic specialist will begin with a thorough physical examination, evaluating your shoulder’s range of motion and checking for pain triggers. They may also ask about your medical history and any recent injuries. In some cases, additional diagnostic tests may be  necessary: 

• X-rays: To rule out other causes of shoulder pain, such as arthritis or fractures. 
• MRI: To obtain detailed images of the soft tissues in the shoulder, helping to identify conditions like frozen shoulder or rotator cuff tears. 

What Does an Orthopaedic Specialist Do? 

An orthopaedic specialist will evaluate your shoulder pain through a combination of physical exams and imaging tests. Depending on the diagnosis, they may recommend the following treatments: 

• MRI Shoulder Scan: If the cause of shoulder pain is unclear, or if there is suspicion of other injuries like a rotator cuff tear, an MRI can provide detailed imaging to guide treatment. 
• Local Injection: Corticosteroid injections may be given to reduce inflammation and pain in the shoulder joint. 
• Physiotherapy: Targeted exercises to improve range of motion, strength, and flexibility are often recommended, particularly in the case of frozen shoulder.
• Arthroscopic Surgery: In severe cases where conservative treatments fail, minimally invasive surgery may be performed to release the tightened shoulder capsule, in conjunction with manipulation of the shoulder under anaesthesia to improve the range of motion. 

Preventing Frozen Shoulder 

While it’s not always possible to prevent frozen shoulder, certain strategies can reduce your risk: 

• Maintain Shoulder Mobility: Regular stretching and strengthening exercises can help maintain the shoulder’s range of motion. 
• Early Intervention Post-Surgery: If you’ve had shoulder surgery, start moving your shoulder as soon as recommended by your doctor to prevent stiffness. 
• Manage Underlying Health Conditions: Keeping conditions like diabetes and thyroid disorders under control can lower your risk of developing frozen shoulder. 

Conclusion 

Persistent shoulder pain should never be ignored, especially if it starts affecting your daily life. If  your shoulder pain hasn’t improved after two weeks of at-home treatments, consult an orthopaedic specialist for a proper diagnosis and treatment plan. Early intervention can help  prevent further complications and improve your chances of recovery. An orthopaedic specialist can provide tailored treatment options, ranging from physical therapy and injections to advanced  surgical procedures if necessary.  

This article has been fact-checked by Dr Henry Chan Ying Ho, orthopaedic surgeon at HC  Orthopaedic Surgery. Mount Elizabeth Medical Centre, Singapore.