Frozen shoulder has 4 stages of the condition:

• Pre-freezing: During this stage, the shoulder is painful and worsens when an attempt is made to move it, but it can still ache even when it is not used. Movement will have decreased by small amounts, which would have reduced the use of the shoulder due to the pain. Pain is most noticeable when the arm is away from the body, with movement loss more noticeable when you raise your arms or reach behind your back. Treatment at this stage is a combination of stretching and manual therapy techniques to reduce your pain and increase your range of motion.
• Freezing: The freezing stage is typically when the symptoms have been experienced for a duration between three and nine months, with a drastic increase in pain at night and a progressive loss of shoulder movement. The range of movement continues to be limited by pain and stiffness. At this stage, the treatment continues to include stretching and manual therapy techniques to enhance the range of motion.
• Frozen: At the frozen stage, which is about nine to fourteen months, the range of motion is dramatically reduced. During the onset of the stage, a substantial amount of pain is experienced, with the pain decreasing towards the end of the frozen stage. The pain may then only occur when the shoulder is moved to the end of the available range of motion. The focus of treatment would be on the return of motion, more aggressive stretching and manual therapy techniques, and strengthening exercises.
• Thawing: Typically, between twelve and fifteen months, the pain has decreased, especially during the night. The range of movement is still limited but is returning to that seen before onset. Treatment includes returning to normal movements, continuing stretching, strength training, and manual therapy techniques.

Causes-

There is no specific cause for the development of frozen shoulders. There are a few factors that increase the risk of developing frozen shoulders:

• Diabetes
• Thyroid disorders
• Parkinsonism disease
• Immobilisation: A frozen shoulder can develop after a shoulder has been immobilised for some duration due to surgery, a fracture, or other injuries. Having patients move their shoulders soon after injury or surgery is one of the measures prescribed to prevent frozen shoulders.

Treatment –

• Non-operative: Most of the patients get relief with anti-inflammatory medications, steroid injections to the joints, and physiotherapy. Patients who do not respond to this form of therapy can undergo a non-invasive procedure called MUA (manipulation under anaesthesia), where the patient will be sedated and the patient’s arm will be moved in every required direction to release the adhesions and increase mobility. The only disadvantage of this procedure is that inadvertent use of it may lead to the development of fractures.
• Operative: arthroscopic release of the thick and tight capsule using a miniature camera is a standard of care wherein the capsule is selectively released. This procedure helps in decreasing the pain and increasing the mobility of the joint.