Do you have “Frozen Shoulder”? And what even is that?

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A “Frozen Shoulder” or adhesive capsulitis is a common complaint that predominantly affects people in their 50s and 60s. Whilst its a well known condition the causes and recovery is a little more vague.

So what exactly is the story with frozen shoulder and what can you do about it if you have it? Here’s the top things you should know about this condition

What is it?

Frozen shoulder is a condition marked by pain and progressive loss of motion in the shoulder. It generally (but not always) follows three phases: freezing, frozen and thawing. Each phase is marked by different characteristics.

  • Freezing – increasing pain and decreasing movement
  • Frozen – stiff shoulder with ongoing pain
  • Thawing – movement increasing again whilst pain subsides

Its caused by changes to the collagen make up of the joint capsule (the connective tissue that wraps around the shoulder joint). Adhesions form and the capsule becomes thickened occasionally with some ingrowth of nerve and blood vessel tissue.

It can come on for no apparent reason (primary) or after a surgery or trauma eg fracture of the shoulder (secondary).

How long does it take to get better?

Most cases of frozen shoulder have recovered in 2 years (some persist longer). Which compared to other conditions that affect the shoulder is a long time!

Making sure the diagnosis is correct

Because frozen shoulder presents differently through the three phases (and because it typically takes so long to get better) it’s important to make sure the diagnosis is correct.

Accurate diagnosis can be made via a thorough physiotherapy examination. Scans like ultrasound can also be used to confirm (but are typically not necessary) the diagnosis.

Three other key conditions that can present like frozen shoulder but get better much quicker with different treatments include:

  • Mechanical shoulder pain (see blog link here)
  • Rotator cuff tendon problems
  • Neck referred problems

Treating the right problem is very important!

What treatments are best for frozen shoulder?
Treatment for this condition really needs to be matched to the phase that its in. Below is a general guide to best treatments for each phase (please note the quality of evidence for effectiveness for these options are moderate at best):

  1. Phase one (freezing stage) – anti-inflammatories (+/- a corticosteroid injection into the shoulder joint) – gentle home based exercises. The aim here is to settle things down – inflammation is the key driver of the symptoms, so in some ways less is more in this phase
  2. Phase two – (Frozen stage) – anti-inflammatories – physio interventions (certain mobilisations) with low- moderate intensity.
  3. Phase three – (thawing stage) – physio interventions involving more progressive strengthening exercises

Other treatment options available include(with less of varied evidence) – dry needling, shockwave therapy or hydrodilatation (where fluid is injected into the shoulder to stretch the capsule.

Occasionally surgical intervention is needed for frozen shoulders that haven’t improved despite a 2 year timeframe. This involves releasing the joint capsule to allow for improved movement.

Conclusion

Frozen shoulder takes a long time to get better but the vast majority of people make a really good recovery. So if you have frozen shoulder remember to stay positive – time is your friend and seek advice as needed to rule out other faster recovering presentations and gain clarity on the right treatment for the phase you’re in.

Physio Winston Hills | Frozen Shoulder

Tim Cathers

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