Frozen shoulder, medically called Adhesive Capsulitis, is a condition usually affecting middle-aged persons, most diabetics. The condition causes severe pain and restriction of movements at the shoulder joint causing impairment of daily activities of the patient. Putting or taking out of shirts and combing hair are the activities most frequently impaired.

This condition evolves through 3 defined stages:

1. The first stage involves severe pain, usually noted in external rotation of the arm (movent where the arm is moved away from the body, as in pushing someone sideways). The patient reports 1-3 months since the onset of the symptoms and that though there is no restriction of movement,  however, to avoid pain, the patient starts limiting the movement at the shoulder joint.

2. The second stage involves pain with increasing restriction of movements. Pain is more especially at night while sleeping over the involved shoulder. External rotation and abduction (as in combing one's own hair) are the movements restricted predominantly. Usually, 3-6 months have elapsed since the onset of the symptom.

3. The third stage involves mainly restriction of shoulder movements with pain. Pain decreases in intensity to some extent and the main problem lies with restriction of movements. Usually, 6-12 months have elapsed since the disease process started.

Etiology

The main cause is capsular adhesions leading to limitation and pain in movements leading to stretching of the capsule. Usually seen in diabetics or in patients with restrictions of shoulder movements for prolonged periods of time.

Treatment

The purpose is to break the capsular adhesions. The latest non-surgical treatment options include hydrosilation of the shoulder joint, suprascapular and axillary nerve blocks, 3 in 1 shoulder blocks, PRP (Plasma) injections if degeneration is the main causative factor.
Hydrodilatation of the shoulder is an OPD-based procedure wherein 40-50 ml of saline is injected in the shoulder joint with ultrasound guidance leading to stretching of the shoulder joint capsule breaking the capsular adhesions.

Neuromodulation of suprascapular or axillary nerves involves numbing the shoulder joint nerves so that patients don't feel pain while doing shoulder exercises without affecting the shoulder joint movements.