Frozen shoulder or adhesive capsulitis is a common source of shoulder pain. While frozen shoulder is commonly missed or confused with a rotator cuff tear, it has a unique pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness.
The more precise medical term for a frozen shoulder is “adhesive capsulitis”. In basic terms, it means that your shoulder pain and stiffness is a result of shoulder capsule inflammation (capsulitis) and fibrotic adhesions that limit your shoulder movement.
What causes frozen shoulder?
Unfortunately, there is still much unknown about frozen shoulder. One of those unknowns is why frozen shoulder starts. There are many theories but the medical community still debates what actually causes frozen shoulder.
What do we know about frozen shoulder?
Frozen shoulder causes your shoulder joint capsule to shrink, which leads to pain and reduced range of shoulder movement. Your shoulder capsule is the deepest layer of soft tissue around your shoulder joint, and plays a major role in keeping your humerus (the ball) within the shoulder socket.
What happens with frozen shoulders?Frozen shoulders have three distinct stages, each of which has different symptoms. The 3 Stages are:
- Freezing – Characterised by pain around the shoulder initially, followed by a progressive loss of range of movement.
- Frozen – Minimal pain, with no further loss or regain of range.
- Thawing – Gradual return of range of movement, some weakness due to disuse of the shoulder.
Each stage can last on average 6 to 8 months if left untreated.
How do I know if I have frozen shoulder?
Frozen shoulder can be diagnosed by your Leading Edge physiotherapist in our clinic from your clinical signs and symptoms.
A clinical diagnosis of frozen shoulder can be determined by a thorough shoulder examination.
Your physiotherapist will ask about what physical activities you are having difficulty performing. Common issues include:
- Unable to reach above shoulder height
- Unable to throw a ball
- Unable to quickly reach for something
- Unable to reach behind your back eg bra or tuck shirt
- Unable to reach out to your side and behind. eg reach for seat belt
- Unable to sleep on your side.
Frozen shoulder is commonly misdiagnosed or confused with rotator cuff tears by inexperienced shoulder practitioners. It is important to get an accurate diagnosis since the treatment and recovery vary considerably.
Who gets frozen shoulder?
Frozen shoulder is more likely to occur in people who are 35-50 years old.
It can be primary, with no known cause, or secondary, associated with an underlying illness or injury.
There are a number of risk factors predisposing you to developing frozen shoulder. These include:
- Shoulder trauma,
- Inflammatory conditions,
- Inactivity of the shoulder,
- Autoimmune disease,
- Cervical cancer
Approximately 20% of people who have had a frozen shoulder will also develop frozen shoulder in their other shoulder in the future.
How do you treat frozen shoulder?Physiotherapy treatment for frozen shoulder depends on what stage you are in, and is tailored to your specific needs.
Freezing - Pain relieving techniques including gentle shoulder mobilisation, muscle releases, acupuncture, dry needling and kinesiology taping for pain-relief can assist during this painful inflammation phase. Intracapsular corticosteroid injection is considered when pain is unbearable. It is important not to aggravate a frozen shoulder during this phase, which is unfortunately a side effect of an overzealous practitioner.
Frozen - Shoulder joint mobilisation and stretches, muscle release techniques, acupuncture, dry needling and exercises to regain range and strength are useful for a prompt return to function. Care must be taken not to introduce any exercises that are too aggressive. Aggressive treatment can aggravate your capsular inflammation and subsequently continue the synovitic process that caused the injury. Your physiotherapist at Leading Edge will know how much is enough and how much is too much.
Thawing - Shoulder mobilisation and stretches are your best chance of a prompt return to full shoulder movement during this “thawing” phase. As your range of motion increases your Leading Edge physiotherapist will be able to provide you with strengthening exercises to control and maintain your newly found range of movement.
I think I have frozen shoulder, what should I do right now?To help your injury resolve as fast as possible:
- Avoid or modify activities and positions, which cause your pain. Recovery is easier if you stop irritating the shoulder.
- Rest your arm on a pillow when sitting for prolonged periods
- Use ice packs for 15 – 20 minutes regularly
- Hug a pillow or rest your arm on a pillow during the night.