Frozen shoulder

What is frozen shoulder?

Frozen shoulder is also called adhesive capsulitis. It presents as difficulty or inability to raise the arm above the head, or move the arm in different directions due to pain or stiffness. It is one of the most painful musculoskeletal conditions. Frozen shoulder occurs in up to 5% of people.

It is common to present with a lot of pain and stiffness. The shoulder capsule becomes inflamed and fibrotic resulting in pain and progressive stiffness. There is a significant restriction in range of motion (typically external rotation). It can take up to 2-3 years to recover.

Signs and symptoms of frozen shoulder

The main symptom is sharp, eye-watering shoulder pain when moving the shoulder, especially in movement of turning shoulder inward, outward and lifting above the head. There is a progressive loss of range in moving the shoulder.

In the early stages, there are difficulties with sleep due to the pain in the shoulder

People with frozen shoulder may have, difficulty:

• reaching behind back to fasten a bra or tuck in a shirt
• taking wallet out of a back pocket
• reaching to put on a seat belt
• throwing a ball
• reaching above shoulders

How to confirm a diagnosis

Involving a physiotherapist in the diagnosis and management plan is best practice.

1. Complete a thorough examination and assessment.
2. Differentiate the diagnosis from rotator cuff injury as the treatment is different.
3. Identify whether there is limited range of movement secondary to mechanical restriction or secondary to pain.

3 Stages of frozen shoulder

It is fairly well understood that frozen shoulder involves several stages. These stages reflect the series of processes from capsular inflammation and fibrosis to spontaneous resolution of this fibrosis.

1. Freezing (pain) phase: from 2 – 9 months.

• gradual onset of severe shoulder pain at rest
• sharp pain at extremes of motion
• pain at night & interrupted sleep.

2. Frozen (stiffening) phase: from 4 – 12 months

• pain starts to subside, stiffness remains
• progressive loss of glenohumeral movements and loss of external rotation
• pain only at extremes of movement.

3. Thawing (resolution) phase: from 4 – 24 months

• spontaneous, progressive improvement in functional range of motion
• resolution of stiffness.

All 3 phases of frozen shoulder overlap by varying amounts

Some studies suggest that frozen shoulder is a self-limiting condition, but can last up to three years. However, other studies have shown that up to 40% of patients may have persistent symptoms and restriction of movement beyond three years. It is estimated that 15% of people may have persistent pain and long-term disability. However, effective treatments which shorten the duration of the symptoms and disability will have a significant value in reducing morbidity.

Risk factors for frozen shoulder

• Diabetes
• thyroid dysfunction disease
• cardiovascular disease
• prolonged immobility
• Parkinson’s disease
• Stroke
• Dupuytrens contracture
• age 40 and 65 years
• females are more commonly affected than males

Managing frozen shoulder

Find a physiotherapist who understands your body’s anatomy and condition and start rehabilitation as soon as possible to speed up the recovery.

• Reducing the pain and starting to get movement back in the shoulder is the first step.
• Starting treatment early and progressing with a tailored treatment and exercise plan will get the best effect.
• Achieving a healthy and strong shoulder with full use is the long-term aim of treatment.

Treatment strategies

Strategies will vary depending on the phase and will include:

• mobilisation
• massage
• taping
• trigger point therapy
• dry needling
• lifestyle modification advice eg for sleeping, dressing
• stretching exercises
• stability exercises
• strengthening exercises

All exercise activities must be in the pain-free range and not provoke pain.

Does physiotherapy work for frozen shoulder?

Yes. physiotherapy is effective for frozen shoulder. Physiotherapy can help speed up the recovery process by reducing pain, improving stiffness and range of motion as well as strengthening the shoulder.

If you think you have a frozen shoulder call us to book an assessment. Our physiotherapists at Hurstville Physio Plus understand your condition and we will get you back on your road to recovery. We will plan your shoulder rehabilitation and give your body the treatment it deserves.