Many of you will have heard of ‘Frozen shoulder’, also called adhesive capsulitis. This condition can be debilitating as it causes pain and stiffness in the shoulder which over time, can make even small everyday movements very difficult.

Let’s look at the anatomy of the shoulder to fully understand what happens.

As you can see, the shoulder joint is actually a shallow ball and socket joint made up of the scapula, the clavicle, and the humerus.

Strong connective tissue called the capsule surrounds the joint. Thick ligaments and tendons also surround and support the joint.

Synovial fluid is produced by the capsule to lubricate the capsule and the joint.

What happens when the shoulder ‘freezes’?

With a frozen shoulder, the shoulder capsule thickens and becomes inflamed, causing stiffness and tightness. Thick bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

The hallmark signs of this condition are severe pain and being unable to move your shoulder — either on your own (actively) or with the help of someone else (passively). It develops in three stages:

Stage 1: Freezing

In the “freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

Stage 2: Frozen

Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.

Stage 3: Thawing

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

What can physiotherapy do to help?

Firstly, come to us early to get a full assessment and properly diagnose your shoulder problem. Once we have done that, we can start early treatment to help with your shoulder flexibility and strength. We can also try pain relief with treatments such as acupuncture or shockwave treatment.

Should we feel that you need an x-ray or other diagnostic tests to rule out other causes, we can arrange for an onward referral.

Who does it affect?

Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at an increased risk of developing a frozen shoulder.

It is estimated that up 8% of men and up to 10% of women will experience a frozen shoulder in the U.K.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation, however, a few factors may put you more at risk for developing a frozen shoulder.

Diabetes. Frozen shoulder occurs much more often in people with diabetes. The reason for this is not known. In addition, diabetic patients with a frozen shoulder tend to have a greater degree of stiffness that continues for a longer time before “thawing.”

Other diseases. Some additional medical problems associated with a frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Immobilisation. A frozen shoulder can develop after a shoulder has been immobilised for a period of time due to surgery, a fracture, or other injuries. If you have recently had an injury or surgery to your shoulder, get in touch as early movement is one of the main preventative measures to developing a frozen shoulder.

Symptoms

The pain from a frozen shoulder is usually described as dull or aching. It is typically worse in the first few months and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.

Treatment

As mentioned before, early diagnosis is very important if your shoulder or upper arm is painful and worsening after an injury or surgery or even for no apparent reason. It may well be that you’re developing a frozen shoulder. We can help with gentle stretching, soft tissue mobilisation, trigger point release, taping, acupuncture or acupressure, shockwave, and postural modification.

Sometimes, we may suggest you see a shoulder specialist to discuss options such as cortisone injection, hydrodilation, or arthroscopy.

We hope this has been helpful.