Women aged 40 to 60 at risk of suffering from frozen shoulder

09 January 2025

KUALA LUMPUR, Jan 9 – Imagine waking up in the middle of the night due to a dull, persistent pain in your shoulder.

Over time, this pain worsens, and what starts off as minor discomfort slowly turns into progressive stiffness and an inability to move your arm.

You might brush it off, thinking it will improve on its own.

If this sounds familiar, you may be dealing with a condition called frozen shoulder (adhesive capsulitis), which can silently affect up to 5 per cent of the population, particularly women aged 40 to 60.

If left untreated, it can lead to prolonged loss of shoulder mobility.

Dr Suresh George Nainan, consultant orthopaedic and trauma, arthroplasty and robotic surgeon at Sunway Medical Centre, Sunway City, shares vital insights on frozen shoulder, including its symptoms, causes, and treatment options.

He stresses the importance of early diagnosis and intervention to prevent long-term stiffness and immobility.

What Exactly Is Frozen Shoulder?

“Frozen shoulder is characterised by inflammation of the shoulder joint, often without any clear cause,” explained Dr Suresh George.

The condition typically begins with progressive pain and stiffness, eventually leading to significant immobility of the shoulder joint. He shares how the condition progresses through three stages:

Freezing Stage: This phase lasts between two and nine months, during which time the pain intensifies and stiffness gradually increases. Many experience shoulder pain that disrupts their sleep.

Frozen Stage: At this point, the pain subsides, but the stiffness worsens with loss of abduction and rotational shoulder movements.

Patients often feel less pain in the frozen stage but find it increasingly difficult to move their shoulders even when aided.

This stage can last from four to 12 months.

Thawing Stage: During this recovery phase, shoulder movement gradually improves. However, a full recovery can take six months to two years.

Most patients eventually regain full function, though some may not make a full recovery.

Who Is At Risk?

Frozen shoulder primarily affects women between 40 and 60 years of age, but certain medical conditions can increase the risk.

“We often see a frozen shoulder in people with diabetes, thyroid disorders, Parkinson’s disease, or cancer,” noted Dr Suresh George.

However, most cases are idiopathic, meaning there is no identifiable cause.

According to some studies, people with diabetes have more than three times the odds of developing a frozen shoulder compared to those without diabetes.

Dr Suresh George also shares a situation with a patient who presented with what appeared to be a frozen shoulder turned out to be cancer, reiterating the importance of getting it diagnosed and treated early to minimise its effects.

Another risk factor is immobility. “A simple injury to the wrist or elbow could indirectly lead to a frozen shoulder due to lack of movement. It is common for individuals who have had their arms in slings or casts for prolonged periods to develop this condition,” he explained.

Diagnosis Of Frozen Shoulder

Despite the complexity of symptoms, diagnosing a frozen shoulder is relatively straightforward.

“A hallmark sign of frozen shoulder is loss of passive range of motion,” said Dr Suresh George.

This means even when someone else tries to move your shoulder, it remains stiff and difficult to manipulate.

While X-rays, scans and blood tests are often used to rule out other potential issues, such as arthritis or tendon injuries, they will not diagnose a frozen shoulder directly.

“Most tests will come back normal for the frozen shoulder, so it’s the classical clinical signs — especially the progressive shoulder pain and stiffness — that lead to the diagnosis,” Dr Suresh George explained.

The Importance Of Early Treatment

“Early diagnosis can significantly shorten the duration and severity of a frozen shoulder,” said Dr Suresh George.

Although most people will eventually recover, early intervention can speed up the process and reduce discomfort.

Treatment is divided into three categories:

• Conservative management includes physical therapy, pain management with anti-inflammatory medications, and exercises to improve shoulder mobility.
• Steroid injections can be administered to reduce inflammation and make movement easier. This can be combined with a controlled shoulder manipulation under anaesthesia if the response to treatment is slow.
• Surgery may be considered in very rare cases if the condition persists beyond 18 months.

“Surgery is a last resort and is only recommended when all other treatments are not effective, as most frozen shoulders without other concomitant pathology will eventually recover,” said Dr Suresh George.

Misconceptions And Myths

One of the most common misconceptions about frozen shoulder is that a quick fix is possible.

“There’s no such thing as curing frozen shoulder overnight. It’s a slow process, and patients need to set realistic expectations about their recovery timeline,” warned Dr Suresh George.

“Patients often come to me worse off after trying aggressive methods like shoulder cracking or deep tissue massages.

“Such treatments can do more harm than good.”

A forceful manipulation could cause a shoulder fracture in an elderly osteoporotic patient or a tear of the rotator cuff tendons.

Preventing Frozen Shoulder

While there’s no guaranteed way to prevent a frozen shoulder, staying active can help.

“For those who’ve had an injury or surgery that immobilises their arm, it’s crucial to start gentle shoulder exercises as soon as possible,” advised Dr Suresh George.

Additionally, incorporating exercises focusing on stretching and flexibility can be highly beneficial.

“Practices like yoga and Pilates encourage shoulder mobility and improve flexibility, which can help prevent the stiffness associated with a frozen shoulder,” said Dr Suresh George.

These exercises stretch the muscles around the shoulder and maintain joint movement, essential for preventing shoulder stiffness.

For individuals with underlying conditions like diabetes or thyroid issues, being vigilant about any developing shoulder pain is also crucial.

Will Frozen Shoulder Return?

Another reason why this is important is that, while a frozen shoulder rarely recurs in the same shoulder, there is a risk it can develop in the opposite one.

“It rarely comes back in the same shoulder, but patients are more likely to develop it in the other within three to five years,” said Dr Suresh George.

Frozen shoulder may not be widely discussed, but its impact can be significant if left untreated.

The key is early diagnosis and a patient-centred treatment approach.

“While it’s a long process, most patients recover fully if they follow the right treatment plan,” reassured Dr Suresh George.

“If you’ve been experiencing persistent shoulder pain or stiffness, don’t wait until you can barely move your arm to visit a doctor,” he said.

“The earlier we catch it, the better your chances of a faster and full recovery.”

Source: OVA

 

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