What it is
Medically know as Adhesive capsulitis, frozen shoulder occurs in the population very frequently, but the good news is once you have had it, it never comes back again on the same side. Contributing factors can include:
• Injury, trauma, surgery or prolonged periods on immobility
• Age (40 – 60 yrs. old)
• More prevalent in females
• Diabetes, Thyroid conditions, Parkinson’s, Cardiovascular disease can predispose.
• Poor biomechanics and posture
What are the symptoms?
There are 3 phases you will experience.
Phase 1 (Freezing stage)
This is when the ‘freezing’ occurs
It can initially start as sharp pain, accompanied by muscular spasm, for no apparent reason.
You will suffer from pain, the worst at night, resulting in waking/disturbed sleep.
The range of movement in your shoulder will begin to reduce due to stiffness
You will be unable to actively and passively move the shoulder in all directions.
Anti-inflammatory’s will not help the symptoms
Phase 2 (Adhesion stage)
Your pain will diminish, but the range of movement will be considerably restricted
You will still experience some pain, but this will be at the end of your range of the movement you have available.
Phase 3 (Resolution/thawing out stage)
This stage sees your range of movement begin to improve through spontaneous return of movement in the joint capsule *
Be aware of other conditions that can mimic a frozen shoulder
Inflammation and degenerative arthritis of the shoulder joint can cause swelling, pain, and/or stiffness, that can mimic the range of motion limitation a frozen shoulder presents with.
Injury to tendons of the rotator cuff which stabilizes the shoulder joint may limit a shoulder’s range of motion, but not typically in all directions.
During examination of a shoulder joint with tendon injury, the physician will be able to move the joint passively beyond the range that you are able to.
How is it diagnosed?
A frozen shoulder is proposed during assessment when the shoulder range of motion is significantly limited, when the patient or the examiner tries the movement.
The diagnosis can be confirmed with an arthrography (on X-ray where contrast dye is injected into the shoulder joint, which will show a shrunken shoulder capsule, if a frozen shoulder is present). An MRI can may also be used to show the integrity of the surrounding shoulder soft tissue.
How can it be treated?
Treating a frozen shoulder can be difficult and patient compliance to improve outcomes is very important.
During the early phase, management can include rest, ice, compression and elevation (RICE).
Sterile water, iced saline or corticosteroid injections can be injected into the effected shoulder capsule.
If your frozen shoulder is being resistant to treatment, surgery can be an option. Arthroscopic surgery or manipulation can be performed to release the capsule and remove/break up any scar tissue, but there is no guarantee this will improve your symptoms.
Frozen shoulders usually go through the 3 stages and resolve spontaneously, but during this time you can help yourself to keep as much function as possible by managing your symptoms.
It is important to keep your shoulder moving through pendula and active assisted range of movement exercise, but you should keep your movement within a pain free range.
Try to avoid aggravating movements i.e. don’t push into end ROM in the overhead position. Instead try to maintain a comfortable range of motion with gentle exercises.
Remedial massage can help to release the soft tissue surrounding the shoulder joint which may have tightened and be contributing to a reduction in your range. Regular massage will help you manage your symptoms until they resolve
On the road to recovery
Once your range of motion begins to return and you are able to move pain free, it is important to focus your training on improving your strength and mobility.
Be sure to include the associated and surrounding musculature of the shoulder joint, which may have atrophied (wasted), to make sure you increase muscle tone and control of the shoulder.
You can begin to incorporate exercise that focus on functional activities you have struggled with and any exercises which will help you return to sport.
Continue with your massage and physical therapy to assist you in a quicker and more successful return to normal movement and use of your affected shoulder