A Patient’s Guide To Frozen Shoulder

Frozen shoulder or adhesive capsulitis is one of the most common causes for pain in the thickening and contraction of the shoulder joint capsule and formation of adhesions, which cause pain, and loss of movement characterize frozen shoulder. It is common in diabetics and commonly affects the non-dominant arm. The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Most common causes for frozen shoulder are:

• Spontaneous onset (no specific cause).
• Following trauma or fractures of the shoulder.
• Following history of Neurosurgery, cardiac surgery, following breast cancer surgery, Neck surgery.

Presentation:

• Commonly affects people between 45-60 years of age
• It usually affects the non-dominant shoulder although it can occur in either shoulder.
• There is usually a gradual onset of severe pain in the shoulder, which is associated with stiffness.
• Restriction of all shoulder movements, both active and passive.
• Inability to sleep on the affected side.
• Restriction of activities of daily living due to impaired movement - e.g. driving, dressing.

Phases of frozen shoulder:

There are 3 commonly recognised phases of frozen shoulder.

• Freezing phase
  • Characterised by pain that affects sleep.
  • Loss of range of motion.
  • Loss of function e.g. putting on a jacket or bra.
  • This can last between 6 weeks to 9 months.
• Frozen
  • Pain lessens
  • Shoulder becomes stiffer with greater loss of movement.
  • Daily activities may be very difficult.
• Thawing
  • Shoulder motion slowly improves during the "thawing" phase.
  • Gradual return to normal or close to normal strength and range of motion
  • Typically can take 6 to 24 months for full recovery.

Diagnosis of frozen shoulder:

• The principal diagnostic test is passive external rotation (bent elbow), which is restricted in contracted (frozen) shoulder.
• Limitation of abduction (movement of arm out to the side) is also restricted both actively and passively.
• An X-ray of the shoulder is done to rule out other causes of shoulder stiffness. In a true frozen shoulder, the X-ray is usually normal.
• MRI scans are sometimes done to rule out other soft tissue pathology that can cause shoulder pain. E.g. muscle tears.

Management:

The focus of treatment is to control pain and restore motion and strength. Conservative management of frozen shoulder aims to restore the normal range of motion.

Pain relief:

• Anti-inflammatory medication is commonly prescribed for pain relief.
• Occasionally steroid injections into the shoulder joint are administered to ease the pain.

Physiotherapy:

Physiotherapy treatment for patients with this condition is vital to hasten the healing process and ensure an optimal outcome. Physiotherapists use a combination of manual therapy and a personalized home exercise program aimed at improving the range of motion.

Surgical management:

If the frozen shoulder does not respond to non-surgical treatment, then surgery to release or stretch the scar tissue is an option. The most common methods include shoulder arthroscopy to release the adhesions.

Manipulation, under anaesthesia, is a procedure that allows the surgeon to move the arm to break up the adhesions.

If you’re suffering from a frozen shoulder, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Ram Peruvemba MPT, BPT - Physiotherapist, Manual Therapist, Sports Therapist

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