Frozen shoulder (also referred to as adhesive capsulitis) is a condition characterised by a significant loss of movement in the shoulder. It is often very painful and at times can be so severe that the shoulder cannot be moved at all, hence the term frozen. In this condition the connective tissue surrounding the joint becomes inflamed, stiff and scar tissue forms, preventing the shoulder from moving freely. Frozen shoulder is a self-limiting condition.
The development of frozen shoulder is often described as having four stages, which may last several months or years. These stages are:
- Painful/niggling: Normal or near normal range of motion but all movements are painful due to inflammation
- Freezing: Continuing pain at rest, gradual loss of movement
- Frozen: Worse pain (day and night), pain on movement at end of range and with fast movement. The joint capsule is scarred and stiff.
- Thawing/Recovery: The shoulder begins to regain movement, with less pain
Causes of Injury
The real cause of frozen shoulder is unknown. In some individuals the condition arises without an obvious event or trigger. In others there may be a history of surgery or an injury of the shoulder before the symptoms developed. This is common if there has been a prolonged period of immobilisation of the shoulder or the initial injury was not adequately managed. There are a number of factors that can increase a person’s risk of developing Frozen Shoulder, including:
- Following surgery or an injury to the shoulder
- Age (most common in people over 40)
- Family history or genetics
- Diseases such as diabetes, thyroid disorders or auto-immune disease
Signs and Symptoms
- Gradual onset of pain, followed by increasing stiffness of the shoulder
- Significantly reduced range of shoulder movement
- Pain aggravated by movement of the shoulder and lying on the affected side
- Pain with every day activities such as dressing/undressing and combing the hair
- The pain is generally a deep throbbing ache in the shoulder, radiating into the arm and possibly the neck
- The individual is likely to avoid using the arm leading to further loss of movement and muscle weakness
In many cases frozen shoulder will settle eventually with time and appropriate physiotherapy treatment. Unfortunately though, once frozen shoulder has been established, there is not a lot that can be done to speed up the recovery process. The aim of treatment is to reduce associated pain and maximise function of the affected shoulder. Treatment and management options include:
- Education about the condition
- Avoidance of aggravating activities
- Anti-inflammatory medication as recommended by a doctor or pharmacist
- Physiotherapy- massage, ultrasound, ice or heat therapy, joint mobilisation and stretches
- Development of a pain-free exercise program aimed at maintaining range of movement, stretching and strengthening.
If symptoms persist, an injection of corticosteroid and anaesthetic medication into the joint may be recommended to assist in reducing pain and inflammation. This can assist to allow the individual to perform the exercise program. Surgery is a last resort treatment. In this case, the capsule is cut to free the joint or the joint may be forcibly moved or manipulated to try and break adhesions and regain movement.
Return to Activity
Unfortunately, healing is very slow but a complete recovery and return to activity can be expected. In some cases full movement is restored, however most individuals will have some degree of ongoing stiffness following a frozen shoulder.