Frozen shoulder also known as “Adhesive Capsulitis”
What is Frozen Shoulder
Frozen shoulder is a self-limiting condition in which the joint capsule becomes inflamed and there is resultant formation of contractures. These contractures in the capsule lead to a progressive decrease in shoulder range of motion. Characteristically frozen shoulder presents with significant decrease in ability to rotate the arm out to the side and lifting out to the side however lifting arm straight above head and rotating arm inwards will often be restricted.
Who gets frozen shoulder
The cause of frozen shoulder remains somewhat unknown. Although it is clinically seen to be more prevalent in the 40-70 year age bracket, females and in the non-dominant arm. There may be a preceding trauma/ period of immobilisation of the shoulder and increased rate of occurrence in the other shoulder following the initial presentation. Links have also been made to frozen shoulder and metabolic conditions such as diabetes. There is limited evidence to suggest genetic link to frozen shoulder although this has been a feature seen clinically.
How does frozen shoulder present
Frozen shoulder is said to progress through three main stages
Initially in the “freezing” stage the shoulder is often at its most painful state with gradual decline in range of movement. In this stage there may be inflammation of the joint capsule and clients may get some relief from anti-inflammatory medication however beyond this stage there is little inflammation and contractures of the joint capsule have developed. During the freezing patients often report
- Night pain, difficulty lying on side
- Pain with rapid/ unguarded movement
- Easily aggravated with movement
- Freezing can last a couple of week to months
The “frozen” stage there is progressive loss of movement however pain may subside and is definitely NOT the key feature. This stage may occur over a number of months with greatest restrictions noticed in arm rotation and lifting arm out to side.
In the “thawing” stage there is spontaneous and gradual improvement in range of movement occurring over weeks to months.
What can be done
Whilst Frozen Shoulder can seem a daunting and long term diagnosis it does spontaneously resolve and you can return to full function. Treatment varies depending on the stage of frozen shoulder. Aims of treatment are to reduce pain, optimise and prevent further loss of range of movement and restoration of strength, muscle control and joint range of movement. A physiotherapist will often provide home exercise program focusing on range of movement and stretching initially which is complemented by manual therapy such as joint mobilisations, muscle release and dry needling in the clinic.
Surgical options are available but are not recommended prior to trying conservative management and do require aggressive physiotherapy immediately post operation to ensure new range of motion is maintained.
Frozen shoulder can be daunting but seeking early physiotherapy treatment can help to optimise your function throughout the process and assist with full recovery.
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