Frozen Shoulder and Chronic Shoulder Pain: Diagnosis, Symptoms and Treatment Options

Frozen shoulder, or adhesive capsulitis, is a condition in which the shoulder joint becomes stiff and painful. The process limits the shoulder’s range of motion, and it can also cause significant pain during movement, at rest or during sleep. The condition usually develops gradually. At first there is pain in the shoulder. Later, patients often feel that the shoulder is “stuck”: it becomes hard to lift the arm, hard to rotate it, and sometimes even simple everyday tasks become a challenge.

Common symptoms include:

• Deep pain in the shoulder area.
• Pain that gets worse at night.
• Difficulty sleeping on the painful side.
• Limited ability to lift the arm.
• Difficulty putting an arm into a sleeve, getting dressed or combing your hair.
• Difficulty rotating the shoulder inward or outward.
• A feeling of stiffness or “locking” in the shoulder.
• Reduced function at work, during exercise and in daily activities.

In frozen shoulder, a process of inflammation, thickening and stiffness takes place in the shoulder joint capsule. The capsule is a sleeve of tissue that surrounds the joint and allows normal movement. When it becomes stiff and inflamed, the range of motion narrows and the pain increases. In many cases there is no single clear cause. Sometimes the condition appears after an injury, after surgery, after a long period in which the shoulder was not moved, or as part of an inflammatory tendency. Some medical conditions may also be associated with a higher likelihood of frozen shoulder, such as diabetes or thyroid disorders.

Frozen shoulder can affect both men and women, but it is more common in middle age and among women. Factors that may raise the risk include:

• Diabetes.
• Thyroid disorders.
• Prolonged immobility of the shoulder.
• An injury or surgery in the shoulder area.
• Underlying inflammatory diseases.
• Shoulder pain that has gone untreated for a long time.

Diagnosis begins with a thorough medical examination. The doctor checks the shoulder’s range of motion, the nature of the pain, how long the symptoms have lasted and how they affect daily function. Diagnosis usually includes:

• A medical conversation about your symptoms.
• A physical examination of the shoulder.
• Testing of active and passive range of motion.
• Ruling out other causes of shoulder pain.
• When needed: X-ray, ultrasound or MRI.

It is important to confirm that the pain really fits frozen shoulder, because shoulder pain can also come from a rotator cuff tear, calcification, tendon inflammation, a problem in the joint itself, a neck problem or other conditions.

In most cases, treatment starts conservatively. The goal is to reduce pain, improve range of motion and help the patient return to function gradually. Treatment options include:

• Tailored physiotherapy.
• Exercises to improve range of motion.
• Medication to relieve pain or reduce inflammation.
• Steroid injections in suitable cases.
• Medical follow-up.

Some patients improve gradually over time. In others, however, the pain and restriction continue despite conservative treatment, and an evaluation for additional treatment may then be considered.

Frozen shoulder is considered persistent when the pain and restriction last for months, interfere with sleep or function, and do not improve enough despite appropriate treatment. Signs that a further evaluation may be worthwhile:

• Shoulder pain that has lasted a long time.
• Significant limitation in lifting the arm.
• Difficulty with everyday function.
• Pain that interferes with sleep.
• No improvement after physiotherapy or injections.
• Reduced quality of life because of the shoulder.

At this stage it is important to re-examine both the diagnosis and the treatment options.

In recent years, a minimally invasive approach has emerged that focuses on small inflammatory blood vessels around the shoulder. In this approach, an interventional radiologist performs embolization: a targeted blockage of small blood vessels linked to the inflammatory process. The aim is to help reduce pain and inflammatory activity in the area, especially in patients whose frozen shoulder has not improved enough with conservative treatment. The treatment is not suitable for every patient, but in selected cases it may be an option before turning to more invasive procedures.

It is worth seeking medical advice when shoulder pain persists, when movement is restricted or when your current treatment is not bringing enough improvement. A consultation can help clarify:

• Whether this is frozen shoulder.
• Whether there is another cause for the pain.
• Which treatments have already been tried.
• Whether further imaging is needed.
• Whether a minimally invasive treatment may be suitable.

Contact Dr. Adam Farkas, a specialist in interventional radiology, to schedule a consultation and find out whether an advanced minimally invasive treatment may be suitable for you.

• Frozen shoulder embolization: the catheter-based treatment, without surgery
• Patient guide: frozen shoulder embolization
• Book a consultation with Dr. Adam Farkas