Frozen Shoulder

Frozen Shoulder or “Adhesive Capsulitis” is a common cause of shoulder pain in people usually between the ages of 40 to 60 years, with women affected more than men. Frozen Shoulder causes the capsule around your shoulder joint to shrink. The role of the capsule is to keep the integrity of the shoulder joint and keep the joint together. The Capsule, by shrinking, causes pain and reduced range of movement of the shoulder.
To date the cause of frozen shoulder is unclear although it has been associated with other medical problems such as diabetes, thyroid problems and a history of previous heart attack. However, frozen shoulder can occur in anyone from the healthy athlete to the inactive elderly person.

Signs and Symptoms

lnterestingly, the non-dominant shoulder appears to be more affected than the dominant shoulder. Those patients with frozen shoulder usually experience 3 distinct phases with differing signs and symptoms.
1. Freezing; characterized by pain around the shoulder initially, followed by a progressive loss of range of movement. Some patients may not notice anything until they struggle, to say, fasten a bra or comb their hair. Eventually over the period of a week/month, the pain can become severe to the point that it interferes with sleep when attempting to lie on the affected shoulder.
2. Frozen; there is minimal pain in the shoulder at rest with no further loss or improvement of range of movement. Pain is initialised with raising the arm upwards, outwards or behind your back.
3. Thawing; there is a gradual return of range of movement usually weakness due to the disuse of the shoulder.
Each stage can last 4-6 months if left untreated although some patients can experience a more rapid recovery.

How is Frozen Shoulder diagnosed?

Frozen Shoulder can be diagnosed from the patient’s signs and symptoms. Common signs include…

  • Unable to reach above your shoulder height.
  • Unable to throw a ball.
  • Unable to quickly reach for something.
  • Unable to reach behind your back i.e. bra or tuck shirt.
  • Unable to reach out to your side and behind i.e. reaching for a seatbelt.
  • Unable to sleep on your affected side.

Treatment

Physiotherapy treatment is the first option for frozen shoulder. The main aim of physiotherapy intervention is to gently stretch the shoulder capsule. This is achieved through performing passive mobilizations which are done at various points in the range of shoulder movement. In addition, the patient must keep up a regular active stretching exercise programme to improve range of movement. There are other treatments including, Dry Kneedling, Shoulder Stabilization techniques, Rotator Cuff exercises, Kinesiotherapy and Strengthening exercises. Some evidence suggests that more aggressive shoulder mobilization in conjunction with local anaesthetic and cortisteroid injection can provide pain relief and help restore range of movement.
If there is no programme after 4-6 months, there is a procedure called (MUA) Manipulation under general anaesthetic, by an orthopaedic consultant, which may be appropriate.
 
For further information or advice, contact your local physiotherapist or GP for assessment and proper diagnosis.
PSJ Keane
Chartered Physiotherapist