Frozen Shoulder

What Is Frozen Shoulder?

Frozen shoulder, technically named Adhesive Capsulitis, is a condition in which the shoulder becomes progressively stiffer and more painful, eventually getting to the point that it is difficult to move the arm much at all. The shoulder joint, like most other joints, is enveloped by a very thin capsule. This is a tissue that is similar in quality to nylon in that it is strong but with some stretch to allow us move our arms with lots of freedom. In frozen shoulder it is this capsule that progressively thickens so that it remains strong but loses its stretch, so becomes more like denim in nature. Frozen shoulder is one of the most debilitating shoulder conditions we see at The Physiotherapy Place as it becomes very difficult to use the arm in question and can be very sore throughout the day and night.

What Are The First Signs Of Adhesive Capsulitis?

People often first report an onset of pain on the shoulder or upper arm but there is commonly no single factor that brings it on. A mild irritation soon turns into a more nagging pain and a restriction in movement of the shoulder soon follows. People often report pain at night in bed, especially when lying on the affected side, and occasionally pain radiates down into the hand.

How Is It Diagnosed?

A diagnosis is made by a series of clinical tests performed by a physiotherapist. The shoulder joint, capsule, and surrounding muscles are tested and if there is a specific pattern of movement loss then a diagnosis of frozen shoulder is made.

What Are The Stages Of Frozen Shoulder?

Frozen shoulder follows 3 distinct stages - freezing, frozen, and thawing.

1. Freezing: In this stage the shoulder gets very painful and becomes progressively stiffer. Movements such as reaching out or putting your hand behind your back are typically very stiff and sore.

2. Frozen: As the condition moves into the frozen stage the pain begins to subside but the stiffness remains. Although inconvenient due to lack of mobility, this stage is much more comfortable as there is much less pain.

3. Thawing: Eventually the shoulder progresses into the thawing stage where the range of motion steadily improves and in most cases returns to normal.

How Long Does Frozen Shoulder Last?

The 3 stages of frozen shoulder can each last anywhere between 3-9 months, meaning that in total the condition can last between 9 and 27 months. If treated promptly and effectively with physiotherapy, the likelihood is that the frozen shoulder will recover towards the lower end of this scale whereas if left to heal on its own it is more likely to take longer.

How Painful Is Frozen Shoulder?

It can very painful in the initial phases. There is usually a constant dull ache in the shoulder but then a sharp pain is felt when the arm is moved or jerked suddenly. It can often disrupt sleep in the early stages and can be difficult to ignore during the day.

How Do We Treat Adhesive Capsulitis?

In order to progress through the stages of frozen shoulder as quickly as possible, a combination of treatments is most effective:

• hands on mobilisation is key to start to get the shoulder moving

• stretching the capsule and surrounding muscles to improve flexibility

• soft tissue release of the muscles around the shoulder. The muscles around the shoulder blade are usually very tight which adds to the pressure on the joint so these muscles need to be released early too.

• Gunn IMS and acupuncture will help with the muscle release and also desensitise irritated nerves

• heat therapy is helpful to reduce pain and increase fresh blood flow to the healing shoulder

Can Frozen Shoulder Go Away On Its Own?

Yes it can, but this will typically take 2 years or more to happen and there is no guarantee that it will completely resolve.

What Exercise Can I Do With A Shoulder That Is Frozen?

Range of motion and stretching exercises are important early on for frozen shoulder as these will get the shoulder joint moving and start to ease the tight capsule. It is important that the exercises aren’t too painful though - a mild ache that resolves quickly after the exercise is expected but if there is more significant pain then you need to back off slightly. You can find some good starter exercises for frozen shoulder here.

What Will A Physio Do?

A physiotherapist will immediately get to work with some hands-on treatment to release the muscles around the shoulder and stretch the joint capsule. Treatments to reduce the pain such as acupuncture and heat will help to relax the shoulder. You will also be guided through a specific exercise program that you can do at home and this will be progressed according to the stage your frozen shoulder is at.