13 November 2018
Frozen Shoulder (Also known as Adhesive Capsulitis) can be a very painful and limiting condition. It is a thickening and contracting of the Glenohumeral (shoulder) joint capsule with resulting pain, stiffness and loss of function.
The exact cause of Frozen Shoulder remains unclear however we do tend to see it in particular groups of people. Females are much more likely than males to get frozen shoulder (70% compared to 30%) however if males do get it they tend to get it worse and for longer.
Idiopathic (Primary) frozen shoulder occurs spontaneously without an event to set it off. There are thoughts that the excessive inflammatory response that creates this may be an abnormal immune system response. Idiopathic frozen shoulder is most liely to occur between the ages of 40-60.
Secondary frozen shoulder can either occur due to trauma to the shoulder (following a fall or surgery etc…) or may be associated with other recognised pre-disposing factors such as diabetes or heart disease. Frozen shoulder is a common complication following stroke as well.
The stages of frozen shoulder
Frozen shoulder can be split into three stages. The first stage is the painful stage, the second stage is the frozen stage and the third stage is the thawing stage.
During the painful stage, patients start noticing pain in their shoulder followed by progressive loss of range. Frozen shoulder tends to fit a specific (What we call capsular) pattern whereby forwards flexion is a little limited, shoulder abduction (arm lifted out to the side) is moderately limited and then rotation (elbow tucked in by the side and rotating the forearm out or trying to reach behind the back) are the most limited.
The frozen stage doesn’t tend to be as painful and in some patient’s pain will ease altogether but the shoulder remains very stiff in the above mentioned pattern. The thawing out stage is the slow recovery of shoulder range.
Time frames for frozen shoulder can be very variable. On average frozen shoulder can take 1.5 years to recover from but this tends to be extended with co-morbidities such as diabetes.
Frozen shoulder is known as a self-limiting condition which basically means that it tends to settle itself down over time, but it is important to educate the patient about what is going on and get them to keep moving their shoulder within a comfortable range to minimise loss of range and function.
Physiotherapy can be used at each stage of frozen shoulder for different reasons. During the initial painful stage, education on what is happening can help reduce fear. As just mentioned it is important to maintain movement and function so exercises at this point within pain limits play an important role in minimise deterioration. Soft tissue work may be used as a pain relief technique for some patients. Physiotherapy becomes particularly important in the thawing stage for exercises to assist with restoring range, strength and function.
Doctors may be able to assist with providing pain relief and anti-inflammatory medication to assist with pain relief, especially at night time. There is minimal evidence for cortisone injections with pain relief only being temporary and a chance of infection.
There are other treatment techniques such as joint manipulation under anaesthetic and hydrodilation (where fluid is injected into the joint space to stretch out the tight capsule). The idea behind both of these are to allow more shoulder range and speed up the process of recovery. There is fairly minimal evidence that these techniques are effective enough to warrant the potential risks when frozen shoulder will resolve over time anyway.
Frozen shoulder can be tough to deal with. It’s painful, it can limit your function dramatically and there is not a magic solution to getting rid of it. Have faith though that time will work it’s wonders and in the mean-time keep that shoulder gently moving to minimise loss of range.