Frozen Shoulder



Frozen shoulder or adhesive capsulitis is a condition where a shoulder becomes painful and stiff. Shoulder movements become reduced and sometimes in severe cases the movement completely freezes in all directions, hence the name "Frozen shoulder".


Our shoulder joint is a ball and socket joint where the ball (head of humerusarm bone) moves inside the socket of scapula (shoulder blade) to give us freedom of movement. The joint is surrounded by a loose fibrous capsule which allows the arm to move in many directions. Whilst enjoying the all round movement, the shoulder joint is well supported with muscles, ligaments and the capsule ensuring that ball remains in the socket all the time.


The frozen shoulder is caused by the inflammation and contraction of the capsule, followed by formation of adhesions hence also known as adhesive capsulitis. In most of the cases stiffness and pain in the shoulder appears suddenly without any history of injury. The causes for frozen shoulder are still unclear and there is an ongoing debate in the research.


Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture. It may follow an injury to the shoulder or surgery.


Frozen shoulder has three stages, each of which has different symptoms. The 3 Stages are:


Freezing:This stage is characterised by pain around the shoulder initially, followed by a progressive loss of range of movement.


Frozen: This stage is with minimal pain but no movement. You will feel like your shoulder is frozen.


Thawing: As this stage begins, the range returns gradually however some weakness will be there due to lack of use of the shoulder.


Each stage can last on average 6 to 8 months if left untreated.


Diagnosis


A thorough shoulder examination is essential for diagnosis of frozen shoulder. The physiotherapists at The Sherwood Clinic are highly experienced in diagnosing various conditions that can affect the shoulder joint. We would ask you about specific physical activities you may have difficulty in performing such as unable to sleep on your side, unable to reach above shoulder height, unable to reach behind your back, for example, tucking in shirt or reach for the bra hook and unable to reach out to your side and behind, for example, reach for seat belt.


Sometimes X-rays or MRI (magnetic resonance imaging) may be necessary to rule out other causes of shoulder pain. However most of the time for an experienced clinician, careful history and clinical examination is sufficient to diagnose frozen shoulder. MRI or preferably MRA (magnetic resonance angiography) can provide a definitive diagnosis.


Frozen shoulder is commonly misdiagnosed or confused with rotator cuff injury by inexperienced practitioners. It is important to get an accurate diagnosis since the treatment and recovery vary considerably. The physiotherapists at The Sherwood clinic will offer you a clear clinical diagnosis.


Management

Most of the symptoms of frozen shoulder resolve in eighteen months, however treatment is beneficial to control the pain and limitation in movement. The key is to treat early, so as to prevent an episode of "capsulitis" becoming "adhesive capsulitis".


During the initial painful inflammatory phase, pain relieving physiotherapy techniques such as gentle shoulder mobilisation, acupuncture, and kinesiology taping can assist. If pain is unbearable, intracapsular corticosteroid injection can be considered, pain killers and anti-inflammatory tablets can help in frozen shoulder to reduce the pain and inflammation, please consult your GP for this. Various treatments may ease pain and improve the movement of the shoulder.


The best way to prevent frozen shoulder is to get the expert advice as soon as possible Get in touch with the Chartered physiotherapists at The Sherwood Clinic to help identify the cause and treat you effectively to get rid of the pain.


Prasad Chakradeo
Senior MSK Physiotherapist
MSc (Sports Injury) MCSP