Frozen Shoulder

If you’re reading this post, chances are you are one of the many individuals grappling with the discomfort, pain, and limitations that come with frozen shoulder, also known as adhesive capsulitis.

Whether you’ve recently been diagnosed, are in the midst of treatment, or are simply seeking information about this condition, you’ve taken a crucial step towards understanding and managing frozen shoulder effectively.

Frozen shoulder can be a perplexing and frustrating condition. It can significantly impact your quality of life and hinder your ability to perform even the most basic daily tasks.

Simple actions like reaching for an object on a high shelf, getting dressed, or even sleeping comfortably can become daunting challenges. The pain, stiffness, and restricted mobility associated with frozen shoulder can lead to feelings of helplessness and frustration.

However, it’s important to know that you are not alone, and there is hope for improvement.

Frozen shoulder is one of the most common shoulder injuries that we treat at Sharp Physiotherapy and with the right knowledge, treatments, and support, you can regain your freedom of movement and reclaim your life.

Frozen shoulder is a condition characterized by pain and stiffness in the shoulder joint. It typically progresses through distinct stages and can last for several months to a couple of years.

The term “frozen” in frozen shoulder refers to the limited range of motion in the shoulder joint, making it feel as if it’s “frozen” in place.

Frozen shoulder typically progresses through three stages:

Stage 1: Freezing (Painful Stage)

• During this initial stage, you’ll experience increasing pain and a gradual loss of range of motion.
• Pain tends to be sharp and worsens with movement.
• This stage can last from a few weeks to several months.

Stage 2: Frozen (Adhesive Stage)

• In this stage, the pain may decrease, but the stiffness intensifies.
• Range of motion becomes significantly limited.
• Daily activities become challenging.
• This stage can last from several months to a year.

Stage 3: Thawing (Recovery Stage)

• In the final stage, the shoulder gradually regains mobility.
• Pain diminishes, and you’ll begin to regain your ability to perform daily tasks.
• This stage can last from several months to a couple of years.

The aim of physiotherapy is to reduce pain, minimise the loss of range of movement and reduce the time spent in each phase.

While the exact cause of frozen shoulder remains unclear, several factors are associated with its development:

1. Age and Gender: Frozen shoulder is more common in individuals aged 40 to 60, and it tends to affect women more frequently than men.
2. Medical Conditions: Certain medical conditions, such as diabetes, thyroid disorders, and heart disease, may increase the risk of developing frozen shoulder.
3. Shoulder Injury or Surgery: A previous shoulder injury or surgery can sometimes lead to the development of frozen shoulder. We refer to this as a post-surgical or post injury frozen shoulder.
4. Immobilization: Prolonged immobilization of the shoulder, such as wearing a sling or cast, can increase the risk.

Understanding the signs and symptoms of frozen shoulder is crucial for early diagnosis and effective management.

Frozen shoulder often starts with subtle warning signs that gradually worsen over time. Here are some of the early indications to watch for:

• Shoulder Pain: The initial symptom of frozen shoulder is usually pain. You may experience a dull ache or sharp pain in your shoulder that tends to worsen with movement.
• Limited Range of Motion: Notice a gradual decrease in your shoulder’s range of motion, especially when reaching overhead or behind your back.
• Difficulty Sleeping: Shoulder pain and stiffness can make it challenging to find a comfortable sleeping position, leading to disrupted sleep patterns.
• Pain at Night: Many individuals with frozen shoulder report increased pain at night, which can interfere with restful sleep.

As frozen shoulder advances through its stages, the symptoms become more pronounced:

• Increased Stiffness: Stiffness in the shoulder joint intensifies, making it challenging to perform routine activities like dressing, combing your hair, or reaching for objects on high shelves.
• Limited Mobility: Your shoulder’s mobility becomes significantly restricted. Activities that once felt effortless, such as putting on a coat or reaching into your back pocket, may become nearly impossible.
• Pain with Movement: Even gentle movements of the affected shoulder can trigger sharp pain. You may notice pain when raising your arm, rotating it, or attempting to lift objects.
• Loss of Function: The combination of pain and limited mobility can lead to a loss of function in your daily life, affecting your independence and overall well-being.

It’s important to note that the signs and symptoms of frozen shoulder can overlap with other shoulder conditions or injuries. Here are a few key differences that can help you differentiate frozen shoulder from other issues:

• Rotator Cuff Injuries: Rotator cuff injuries often involve acute pain following an injury, while frozen shoulder typically develops gradually over time.
• Osteoarthritis: Osteoarthritis may cause chronic shoulder pain, but it doesn’t typically result in the severe stiffness and loss of mobility seen in frozen shoulder.
• Bursitis: Bursitis can cause shoulder pain, but it tends to improve with rest and worsen with movement, whereas frozen shoulder pain often persists at night.

Physiotherapy is a highly effective option for treating frozen shoulder can alleviate pain, improve mobility, and enhance your overall quality of life.

Conservative treatments are often the first line of defence against frozen shoulder, particularly in the early stages. These methods focus on reducing pain and inflammation while improving shoulder mobility.

Physiotherapy plays a central role in the management of frozen shoulder. A physiotherapist can deliver hands on treatment and develop a personalized exercise regimen to improve your shoulder’s range of motion.

Physiotherapy for frozen shoulder often consists of:

• Manual Therapy: Techniques such as massage, muscle energy techniques, PNF stretches and joint mobilization may be used to alleviate pain and improve mobility.
• Range-of-Motion Exercises: Specific stretches and range-of-motion exercises help increase flexibility in the shoulder joint and prevent freezing.
• Strengthening Exercises: Targeted exercises to strengthen the muscles that support the shoulder can improve stability and function.
• Heat & Cold Therapy: Applying heat or cold to the affected shoulder can provide temporary relief. Heat can help relax tight muscles, while cold therapy can reduce inflammation and numb the area.

When conservative treatments do not provide sufficient relief, or if the condition has progressed to an advanced stage, minimally invasive procedures should be considered.

1. Joint Distension

In this procedure, a sterile fluid is injected into the shoulder joint to expand the joint capsule. This can help improve range of motion and alleviate pain.

2. Hydrodilatation

Hydrodilatation is a specialized form of joint distension that involves injecting a combination of sterile fluid and corticosteroid into the joint. It is performed under imaging guidance.

3. Manipulation Under Anesthesia (MUA)

MUA is a procedure in which the patient is put under anesthesia, and the healthcare provider manipulates the arm to break up adhesions and improve mobility.

In rare cases where other treatments have failed, surgical intervention may be necessary. Surgical options for frozen shoulder may include:

4. Arthroscopic Capsular Release

During this procedure, a surgeon makes small incisions in the shoulder and uses specialized instruments to release tight portions of the joint capsule.

5. Manipulation Under Anaesthesia (MUA)

MUA, mentioned earlier as a minimally invasive procedure, can also be performed as a surgical intervention to break adhesions while the patient is under anaesthesia.

It is worth noting that the majority of our patients who experience frozen shoulder respond well to conservative treatments and do not require further interventions such as injections or surgery.