Frozen Shoulder

Frozen shoulder is an adhesive capsulitis that occurs in 1.7% of the population. The cause is unknown but hormonal changes can be a factor.

The incidence of frozen shoulder in- crease if you suffer other systemic dis- eases such as diabetes, cardiac disease and neurological diseases such as Parkinsons. As such we consider this a “sick” shoulder and your physio will ask you questions about your general health. It also increases to 18% after shoulder trauma, shoulder surgery and mastectomy. (Green et all 2002)

A frozen shoulder is thought to be an inflammatory reaction in the capsule of the shoulder. It goes through 4 phases.

Stage 1

Painful phase – 3 months approximately

Symptoms include:

  • gradual onset
  • aching over the shoulder
  • inability to sleep on this side
  • mild limitation of movement

Stage 2

Freezing stage – 3-6 months

  • night pain
  • significant loss of both active and passive movement
  • histology shows scar formation in the capsule

Stage 3

Frozen stage – 9 – 14 months

  • shoulder stiff
  • pain at extreme of range and night pain
  • biopsy shows dense hyper cell scar collagenous tissue

Stage 4

Thawing stage – 15- 24 months

  • minimal pain
  • gradual improvement of range of movement due to capsular remodelling

Treatment for frozen shoulder

Stage 1-2

It has been shown to be very important in the early stages of a frozen shoulder avoid moving into pain. This will make your shoulder worse and the recovery will be slower. Your physiotherapist will tape to unload the painful area and reduce the pain and possibly loosen the surrounding joints particularly your upper back. (not your shoulder!!) Anti- inflammatory and pain relief medication may be useful in this stage. It is important you don’t push into pain in this stage.

During the painful phase an ultrasound guided corticosteriod injection may be of benefit to help reduce pain in some cases.

Stage 3-4

Once you have entered the thawing/ stiffness stage your physio will do gentle mobilising techniques to your shoulder. It is also important to retrain your stabilising muscles. A home programme will be included to ensure your shoulder recovers full range. Work on fitness, core control, posture, maintain movement and have patience.

Important to note

Frozen shoulder is a difficult problem to manage

  • It requires patience and perseverance
  • Respect the pain and don’t push it especially in the early stages.
  • Keep your upper back mobile
  • Avoid sustained slumped sitting
  • When the pain has settled train your control muscles.
  • For the best result it is important to return to your physio at stage 3 for ongoing management.
  • Follow a home programme to restore your movement in the stiff phase.