What is frozen shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the shoulder joint, causing pain and stiffness. It often involves a gradual onset of symptoms with disabling shoulder pain that progressively becomes stiff over time. This condition can last 12-18 months and in some cases up to two years. Frozen shoulder affects up to 5% of the general population and 30% of those people with diabetes.
The exact cause of frozen shoulder is still not fully understood, but it is believed that the capsule surrounding the ball and socket can become thickened and contracted over time, making it very hard to move. Interestingly, a recent study found that there is also a huge muscle guarding component to frozen shoulder where the muscles surrounding the shoulder joint restrict the shoulder from moving freely.
Frozen shoulder can be classified into primary and secondary frozen shoulder.
- (Idiopathic) frozen shoulder is that without any known cause
- Intrinsic: For example chronic rotator cuff pathology causing frozen shoulder
- Extrinsic: For example fractured collarbone, cervical nerve root compression or breast surgery causing frozen shoulder
- Systemic: For example, diabetes and hypothyroidism causing frozen shoulder
- Severe loss of range of motion
- Gradual onset of shoulder pain
- Reduced function – unable to dress, bath, drive etc.
- Usually one sided
- ‘Stuck” shoulder
Image credit: Jared Powell @shoulder_physio
Although no definitive cause has been identified, there are a number of risk factors predisposing a person to developing a frozen shoulder condition. This includes:
- 40-60 years of age
- Female (more common in women than men)
- Diabetes – 30% of people with diabetes will go on to develop a frozen shoulder
- Associated with hypothyroidism and Dupuytren’s contracture
- Previous shoulder injury: rotator cuff, neck pain, collarbone fracture, breast surgery
- Injury resulting in a period of immobility
Diagnosis & Imaging
Frozen shoulder can be diagnosed by your physiotherapist. It can be diagnosed when there is an equal restriction between active (how much you can actively move your shoulder) and passive (how much your shoulder can move when your physiotherapist moves it through range) range of motion and in the presence of a normal x-ray. Your physiotherapist may send you for an x-ray to rule out any other problems that may be causing your symptoms.
Frozen shoulder is often not something that will resolve on its own. If left untreated, it may progress to a persistently painful and irritated shoulder. Recovery from frozen shoulder is much better if actively treated with exercises in conjunction with some passive techniques.
Treatment of frozen shoulder will often include a combination of the following:
- Education and advice regarding postures and activity modifications can be helpful in managing the pain and discomfort associated with frozen shoulder
- A corticosteroid injection can provide pain relief and assist function in the early stages, however this does not resolve the condition, although it can be a good adjunct to treatment
- Stretching and manual therapy: massage, gentle joint mobilisation and dry needling can help to address stiffness, muscle guarding and reduce pain
- Exercise such as stretching, strengthening and range of motion exercises to minimise muscle loss, improve confidence in movement and regain functional use of shoulder
- Hydrodilatation injection is an injection which aims to “stretch” the joint capsule to reduce the contracture of the tissue and can help to free the shoulder joint. This is often used in the later stages of frozen shoulder and should be considered as a secondary option
- Manipulations under anaesthetic and surgery to resolve frozen shoulder should be the last resort as outcomes after surgery are not that great
Frozen shoulder is a debilitating injury, if you are experiencing frozen shoulder or have any of the symptoms listed above, we would love to help you through this condition so please get in touch with us.