The medical name for this condition is adhesive capsulitis. It is caused by severe inflammation of the capsule (connective tissue) that surrounds the shoulder joint. When the shoulder is looked at through key-hole surgery we will often see a very red inflamed and tight joint capsule. It is more common in women than men. It occurs mostly in patients over 40 years of age and more frequently in those with diabetes. It can happen following a trauma or surgery, but this is often not the case appearing in those who have sustained no previous injuries.
Signs and symptoms
A frozen shoulder can often be painful at night, it is one of the few shoulder problems that can cause problems through the night. Patients often complain of an inability to sleep on their affected side due to pain.
When compared with rotator cuff (muscle) injuries or impingement, the patient will often have a global reduction in range of movement, especially turning the arm out to the side (abduction). There are no scans or X-rays to diagnose a frozen shoulder, just symptoms and movement tests. Patients will, however, often find the symptoms will follow a fairly distinctive pattern:
- The first stage, often called the ‘freezing’ stage, the patient will have a painful shoulder with increasing stiffness.
- The second ‘frozen’ stage will mean the patient’s shoulder will become very stiff, but not necessarily painful.
- The final ‘thawing’ stage is often characterised by an increase in shoulder movement.
Typical daily activities that become difficult for those suffering with a frozen shoulder are:
- Putting the affected hand behind your back for example, to fasten your bra, or to reach inside your back pocket
- Sleeping on the affected side
- Stretching the arm out to the side, to do activites such as closing the car door
How physiotherapy can help
Response to treatment can be slow. It is fairly well acknowledged that physiotherapy can be the most helpful in the frozen and thawing stage, that is, once the initial pain has subsided. Treatment would usually include soft tissue massage, joint mobilisations and stretches, acupuncture, and electrotherapies. Once movement has begun to increase strengthening rehab plays a vital role in restoring lost shoulder power which is often becomes impaired during a frozen shoulder.
In most cases a frozen shoulder will eventually get better, but this may take up to two years to resolve. Some patients are happy to manage their symptoms with pain killers and activity modification. Other options that may aid in speeding up the recovery from this condition include; an injection usually by an orthopaedic surgeon, which can help with pain relief but won’t restore motion; a manipulation of the shoulder joint under anaesthetic or capsular release, followed by physiotherapy. These are options to consider if the movement impairment is significant or too painful to manage.