Frozen Shoulder

What is Frozen Shoulder?

Also known as Adhesive Capsulitis and Shoulder Contracture, Frozen Shoulder is a poorly understood musculoskeletal condition involving the shoulder joint, causing chronic pain, stiffness and inflammation. In some cases, this may be debilitating, as everyday tasks such as dressing and washing become too painful and the shoulder literally becomes ‘frozen’.

Frozen Shoulder is a chronic pain condition lasting anything from approximately one and a half to two years, although it may last up to five years in severe cases.

A unique anatomical structure, the shoulder joint provides us with an exceptional range of movement. It is a ball and socket joint, with the head of the humerus (the shoulder ball), covered by a capsule of muscles, tendons, ligaments and other tissue – these control the movement of the shoulder and prevent it from dislocating. Frozen Shoulder occurs when this capsule of tissue around the shoulder joint becomes inflamed – it then tightens making it difficult, or in more severe cases, impossible, to move.

Diagnosing Frozen Shoulder

A detailed medical history with a physical examination is usually the first step towards a diagnosis. Specific physical symptoms must be present in order to reach a diagnosis of Frozen Shoulder, these include:

• Thickening of the synovial capsule
• Adhesions to the biceps tendons
• Adhesions within the subacromial or subdeltoid bursa

Imaging tests such as X-Ray are used to rule out the possibility of other conditions such as arthritis or dislocation.

Causes of Frozen Shoulder

Why Frozen Shoulder occurs, is not fully understood. However, there are number of other medical conditions believed to increase the risk of developing Frozen Shoulder.

Diabetes and Other Medical Conditions

People with diabetes have a greater chance of suffering from Frozen Shoulder, as well as other musculoskeletal conditions. The reasons as to why diabetics are more likely to suffer from Frozen Shoulder are poorly understood, however some research suggests that uncontrolled blood sugars may cause changes to the connective tissue in the shoulder.

Other associated conditions may include the following; cardiac disease, stroke, hyperthyroidism, hypothyroidism, Parkinson’s disease, pulmonary disease, and in some cases other non-related surgical procedures.

Age and Gender

Women aged between 50 and 70 appear to be more prone to developing Frozen Shoulder, although it can also occur in men.

Pre-Existing Shoulder Issues

Having a pre-existing shoulder condition such as Tendonitis or a Rotator Cuff Tear may also increase the likelihood of developing the disorder. Injury, trauma and repetitive strain to the shoulder may also contribute.

Symptoms

Frozen Shoulder is characterised by acute and chronic pain and disability both within the shoulder region. It usually occurs in one shoulder only, however, in rare cases it may develop bilaterally.

The disorder typically presents itself in three clinically categorised phases; The Freezing Stage, The Frozen Stage and The Thawing Stage.

Phase 1 – The Freezing Stage

The Freezing Stage is often the most painful, lasting anything from 3 to 9 months – pain gets progressively worse while range of movement (ROM) becomes more and more restricted.

Phase 2 – The Frozen Stage

This phase is referred to as the Frozen Stage, as the shoulder is now at its stiffest, it usually lasts from approximately 4 to 12 months. Pain does not worsen, however limited use of the arm may lead to wasted muscle. Towards the end of this phase painful symptoms should begin to cease during movement, as the disorder transitions into its final phase.

Phase 3 – The Thawing Stage

This final phase sees a gradual return to shoulder mobility as painful symptoms lessen and ROM improves. Typically, this phase lasts anything between 12 to 42 months, although it can take several years in some cases.

Treatment

Treatment is focused on relieving the pain and restoring the shoulder’s normal ROM – this is usually achieved through a combined treatment plan of pain relief medication, physiotherapy, corticosteroids and in some cases, surgery.

Pain Medication

Analgesics and NSAIDs, or in more severe cases, stronger prescription-based medication may be required.

Physiotherapy

Physiotherapy used in conjunction with other treatments is highly beneficial to regaining movement of the shoulder. Treatments may include specific stretching exercises which stretch the joint capsule and improve mobility, followed by strengthening exercises. Massage and manipulation may also be effective as well as other therapy treatments such as thermotherapy (hot or cold packs).

Physiotherapy can help to educate the patient, by teaching effective exercises and showing them how far they can push themselves – having learned their limitations and the correct technique, these exercises can also be practised at home. A physiotherapist can also provide useful advice on which activities should be avoided and how to practice maintaining correct shoulder posture.

Corticosteroid Injections

A corticosteroid injection administered into the shoulder joint can relieve the swelling and provide pain relief.

Surgery

Surgery may be considered in extreme cases when all other treatment methods have failed.

How We Can Help

ProPhysiotherapy offers a range of physiotherapy and rehabilitation services, all of our physiotherapists are exceptionally well qualified. If you are suffering from Frozen Shoulder or suspected Frozen Shoulder, don’t hesitate to get in touch today on Earlsfield: 020 8879 1555 and Wimbledon: 020 8946 2800