Frozen Shoulder Treatment in Singapore

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by stiffness and pain in the shoulder joint. It occurs when the capsule surrounding the shoulder joint thickens and tightens, restricting movement and causing discomfort. Frozen shoulder typically develops gradually over time, with symptoms worsening before eventually improving. The condition can significantly limit daily activities such as dressing, reaching overhead, or performing routine tasks that require shoulder mobility.

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Symptoms of Frozen Shoulder

Individuals with frozen shoulder may experience various symptoms that typically progress through three distinct phases. These symptoms can interfere with daily activities and sleep.

Pain

Persistent shoulder pain, often worse at night, making it difficult to sleep on the affected side. The pain may extend from the shoulder into the upper arm.

Stiffness

Progressive limitation in shoulder movement, both active (movements you perform) and passive (movements performed by someone else on your shoulder).

Range of Motion Restriction

Difficulty performing activities that require raising the arm or reaching behind the back, such as putting on a coat or fastening a bra.

Gradual Onset

Symptoms that develop slowly over weeks to months, rather than appearing suddenly after an injury.

Three-Phase Progression

Movement through a freezing phase (increasing pain), frozen phase (decreasing pain but increasing stiffness), and thawing phase (gradual improvement in mobility).

Causes and Risk Factors

Frozen shoulder develops when the capsule surrounding the shoulder joint becomes inflamed, thickened, and contracted. Several factors can contribute to its development or increase the likelihood of experiencing this condition.

Age and Gender

More common in people between 40 and 60 years of age. Women are affected more frequently than men.

Prolonged Immobilisation

Extended periods of reduced shoulder movement, such as after surgery, an injury, or a stroke, can trigger frozen shoulder.

Systemic Diseases

Certain medical conditions increase the risk, including diabetes, thyroid disorders, cardiovascular disease, and Parkinson’s disease.

Previous Shoulder Trauma

A prior injury or surgery to the shoulder area can lead to frozen shoulder development during recovery.

Inflammatory Conditions

Chronic inflammatory states in the body may contribute to the development of adhesive capsulitis.

Diagnostic Methods

Clinical Examination: A physical assessment is conducted, where the doctor evaluates both active and passive range of motion in the shoulder. Characteristic findings include limited external rotation and abduction of the shoulder, with pain at the extremes of movement.
Medical History Review: Detailed discussion about symptom progression, prior injuries, existing medical conditions, and current limitations. The classic history of gradual onset pain followed by stiffness supports the diagnosis.
Imaging Studies: X-rays typically appear normal but can help exclude other conditions like arthritis or fractures. MRI or ultrasound may show thickening of the joint capsule and decreased volume within the shoulder joint.

Treatment Options

Treatment for frozen shoulder focuses on addressing pain and maintaining or improving shoulder mobility. The approach differs based on which phase the condition is in and how severe the symptoms are.

Pain Management: Over-the-counter pain relievers and anti-inflammatory medications can help control pain and reduce inflammation. These medications allow for more comfortable participation in physical therapy and daily activities.

Physical Therapy: Supervised stretching and range-of-motion exercises help maintain and improve shoulder mobility. A therapist can provide a home exercise programme tailored to the current phase of frozen shoulder.

Heat and Cold Therapy: Application of heat before exercises helps relax tissues, while cold applications after activity can reduce inflammation. These modalities can be used at home as part of self-management.

Corticosteroid Injections: Injection of corticosteroid medication into the shoulder joint can provide temporary pain relief during the painful freezing phase. This treatment works best when combined with physical therapy.

Manipulation Under Anaesthesia: A procedure where the doctor moves the shoulder in different directions while the patient is under general anaesthesia. This breaks up adhesions and scar tissue but does not involve surgical incisions.

Arthroscopic Capsular Release: A minimally invasive surgery where a surgeon cuts through tight portions of the joint capsule using small instruments inserted through tiny incisions. This procedure directly addresses the contracted tissue.

Shoulder Arthroscopy with Manipulation: A combined approach that includes both manipulation and arthroscopic release during the same procedure. This combination can be effective for stubborn cases not responding to other treatments.

Prevention and Management

While frozen shoulder cannot always be prevented, certain strategies may reduce the risk and help manage the condition. Maintaining shoulder mobility through regular exercise, especially after injuries or surgeries that affect the shoulder, can prevent stiffness from developing. For those with diabetes or other risk factors, addressing shoulder pain early and seeking treatment may limit progression. Once diagnosed, following prescribed physical therapy and home exercise programmes assists recovery. During the recovery period, adapting daily activities to work within mobility limitations while continuing to use the shoulder within a comfortable range maintains function. Applying heat before exercises and cold afterwards can manage discomfort associated with therapeutic movement.

Are Your Symptoms Affecting
Your Quality Of Life?

Consult our Dual Fellowship-Trained Orthopaedic Surgeon for an accurate diagnosis & personalised treatment plan today.

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

MBBS (S’pore)
MRCS (Ireland)
MMed Orthopaedic (S’pore)
FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

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Frozen Shoulder

Frequently Asked
Questions

How long does frozen shoulder last if left untreated?

Without treatment, frozen shoulder typically progresses through the three phases over 1-3 years. The condition generally resolves on its own eventually, but this prolonged period of disability can significantly impact quality of life.

Will frozen shoulder come back after it heals?

Recurrence in the same shoulder is rare after complete recovery. However, some people may experience mild residual stiffness or subtle movement limitations even after successful treatment.

What exercises should be avoided with frozen shoulder?

Aggressive stretching beyond pain tolerance and heavy lifting should be avoided, particularly during the freezing phase. Forcing the shoulder beyond its comfortable range can worsen inflammation and pain.

Frozen Shoulder Treatment in Singapore