Frozen shoulder

Frozen shoulder is characterized by a locked shoulder that evolves in three distinct phases:
1. Painful phase
Initially, pain is the predominant symptom. Shoulder movements become increasingly limited and painful, to the point of affecting sleep.
2. Blocking phase
During this phase, shoulder mobility is considerably reduced in all directions, making daily activities very difficult. However, the pain is no longer as intense.
3. Recovery phase
Finally, the stiffness begins to fade gradually, allowing the shoulder's mobility to return gradually. This "thawing" phase can last from 6 months to 2 years.

However, this sequence is not immutable and recent studies have not confirmed either the sequence or the duration of symptoms.¹

The exact causes of frozen shoulder remain unclear, but several factors seem to contribute to it. Symptoms often appear following trauma to the upper limb or prolonged immobilization of the shoulder, such as after surgery or a fracture. Certain medical conditions such as diabetes and thyroid disorders also increase the risk of developing this condition.

Although frozen shoulder can affect anyone, certain factors increase the risk of developing this condition:

• Diabetes
• Thyroid disorders
• Age and gender: people aged 40 to 60 and women are more at risk

Diagnosis can usually be made on the basis of the patient's history and clinical examination. However, X-rays of the shoulder should be performed systematically to rule out an underlying disorder responsible for mechanical blockage. This is usually the only examination performed. Magnetic resonance imaging (MRI) is indicated for preoperative assessment. However, there is generally no indication for surgery during the course of the disorder. This costly test is therefore not useful for initial management.

In most cases, conservative (non-surgical) treatment is recommended. It aims to relieve pain and combat stiffening through a variety of approaches:

Non-surgical treatments

Anti-inflammatories and analgesics are generally prescribed to reduce pain and inflammation. Intra-articular corticosteroid infiltration is generally proposed. This is the most effective isolated action². Daily intake of natural vitamin C or dietary supplements may have a beneficial effect on frozen shoulder.

Physiotherapy
Gentle mobilization physiotherapy sessions, either dry or in the pool, are often recommended to soften the shoulder, relieve pain and boost patient motivation. Strengthening exercises using elastics, dumbbells or floats are not recommended.

Self-mobilization and flexibility exercises
These exercises should be carried out as soon as the diagnosis has been made, and are a key element in the treatment of frozen shoulder. They should be performed regularly in accordance with the doctor's and/or physiotherapist's instructions.

Surgical treatment

In rare cases, surgical intervention (arthroscopic arthrolysis) may be considered. This is exceptional, as full recovery is achieved in the majority of cases with conservative treatment.

With proper management, the vast majority of patients regain normal or near-normal shoulder mobility within a few months. However, residual stiffness may persist, particularly in diabetic patients. Recurrence is also possible if risk factors persist.

Although it is difficult to prevent frozen shoulder with certainty, certain measures can reduce the risk, including:

• Avoiding prolonged immobilization of the shoulder after trauma or surgery
• Controlling pre-existing pathologies such as diabetes
• Staying active and practicing regular shoulder mobilization exercises.

Increasing pain or limitation of shoulder movement warrants medical attention. Early diagnosis and treatment will help manage symptoms and prevent frozen shoulder from worsening.

At Hôpital de La Tour, a multidisciplinary team of orthopedic surgeons and physiotherapists support patients in the overall management of frozen shoulders.

What are the symptoms of frozen shoulder?
Early signs include persistent pain and stiffness in the shoulder, particularly during movement.

How long does a frozen shoulder last?
The total duration of a frozen shoulder that is not properly treated generally varies between 1 and 3 years, with a 3-phase evolution (painful, blocked and recovery).

Is frozen shoulder the same thing as osteoarthritis?
No, they are two different conditions. Osteoarthritis is caused by degeneration of the articular cartilage, whereas frozen shoulder involves stiffening of the joint capsule.

Can frozen shoulder resolve itself?
Yes, in some cases frozen shoulder can resolve spontaneously over time without specific treatment. However, appropriate treatment can usually speed up recovery and limit residual stiffness. Mobility and flexibility exercises, such as stretching, are often recommended.

What are the treatments for frozen shoulder?
Treatments include anti-inflammatory drugs, injections, physiotherapy and, in some cases, surgery.

Can frozen shoulder be prevented after shoulder surgery?
Early mobilization of the shoulder after surgery is recommended to prevent the development of frozen shoulder.

Does frozen shoulder always affect the same shoulder?
No, frozen shoulder can occur in any shoulder, whether dominant or non-dominant.

Does a frozen shoulder require complete immobilization?
No. On the contrary, it's advisable to continue mobilizing the shoulder as far as possible to prevent stiffening from worsening.