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Frozen Shoulder (Adhesive Capsulitis)

What is Frozen Shoulder?

Frozen shoulder or adhesive capsulitis is a common source of shoulder pain.

While frozen shoulder is commonly missed or confused with a rotator cuff injury, is does have a distinct pattern of symptoms resulting in severe pain, loss of function and eventually stiffness. hence the word "frozen" aptly describes this condition although only in stage two or three.

The more precise medical term for a frozen shoulder is "adhesive capsulitis". In basic terms, it means that your shoulder pain and stiffness is a result of shoulder capsule inflammation (capsulitis) and fibrotic adhesions that limit your shoulder movement.

What Causes Frozen Shoulder?

Unfortunately, there is still much unknown about frozen shoulder. One of those unknowns is why frozen shoulder starts. There are many theories but the medical community still debates what actually causes frozen shoulder.

What is known is that frozen shoulder causes the capsule of your shoulder to shrink, which leads to pain and reduced range of shoulder movement. Your shoulder capsule is the deepest layer of soft tissue around the joint, and plays a major role in keeping your humerus within the shoulder socket.

Who Suffers from Frozen Shoulder?

Frozen shoulder is more likely to occur in people who are 35-50 years old. It can be primary, with no known cause, or secondary, associated with an underlying illness or injury.

There are a number of risk factors predisposing you to developing frozen shoulder.

These include:

shoulder trauma,
surgery,
diabetes,
inflammatory conditions,
inactivity of the shoulder,
autoimmune disease,
cervical cancer, and
hyperthyroidism.

Approximately 20% of people who have had a frozen shoulder will also develop the condition in their other shoulder in the future.

What are Frozen Shoulder Symptoms?

Frozen shoulder has three stages, each of which has different symptoms.

The 3 Stages are:

Freezing – characterised by pain around the shoulder initially, followed by a progressive loss of range of movement. Known as the RED phase due to the capsule colour if you undergo arthroscopic surgery.

Frozen – minimal pain, with no further loss or regain of range. Known as the PINK phase due to the capsule colour if you undergo arthroscopic surgery.

Thawing – gradual return of range of movement, some weakness due to disuse of the shoulder. Known as the WHITE phase due to the capsule colour if you undergo arthroscopic surgery.

Each stage lasts on average 6-8 months if left untreated.

How is Frozen Shoulder Diagnosed?

Frozen shoulder can be diagnosed in the clinic from your signs and symptoms. In some cases you may be referred for X-rays or MRI to rule out other causes of shoulder pain. X-rays are not able to diagnose frozen shoulder. MRI or preferably MRA can provide a definitive diagnosis. A double-contrast shoulder arthrography is the traditional diagnostic method, although this is usually not required if you have a skilled clinician.

A clinical diagnosis of frozen shoulder can be determined by a thorough shoulder examination. Your physiotherapist will ask about what physical activities you are having difficulty performing. Common issues include:

Unable to reach above shoulder height

Unable to throw a ball

Unable to quickly reach for something

Unable to reach behind your back eg bra or tuck shirt

Unable to reach out to your side and behind. eg reach for seat belt

Unable to sleep on your side

Frozen Shoulder Physical Examination

Your physiotherapist will ask you to perform shoulder movements. Frozen shoulder has a distinct capsular pattern of stiffness:

Lateral Rotation > Flexion > Internal Rotation

Normally, your strength will still be normal with the exception of pain inhibition. Frozen shoulders are commonly non-tender on palpation examination due to the pathology being quite deep. Quick movements are very painful with patients very keen to avoid any fast movements such as reaching or throwing and catching.

A good diagnosis is the key to providing the best treatment for you. Frozen shoulder has a totally different treatment regime to rotator cuff injuries or bursitis, so an accurate diagnosis is vital.

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Frozen Shoulder Treatment?

Physiotherapy treatment for frozen shoulder depends on what stage you are in, and is tailored to your specific needs.

Freezing

Pain relieving techniques including gentle shoulder mobilisation, muscle releases, acupuncture, dry needling and kinesiology taping for pain-relief can assist during this painful inflammation phase. Intracapsular corticosteroid injection is considered when pain is unbearable.

Frozen
Shoulder joint mobilisation and stretches, muscle release techniques, acupuncture, dry needling and exercises to regain range and strength are useful for a prompt return to function. Care must be taken not to introduce any exercises that are too aggressive. Overzealous exercises can reaggravate capsular synovitis and subsequent pain. a quality shoulder physiotherapist will know how much is enough and how much is too much.

Thawing
Shoulder mobilisation and stretches are your best chance of a prompt return to full shoulder movement. As your rnage of motion increases your physiotherapist will be able to provide you with strengthening exercises to control and maintain your newly found range of movement.

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Can You Prevent Frozen Shoulder?

While the spontaneous onset frozen shoulder is of unknown origin, you can prevent frozen shoulder caused by disuse by avoiding long period of shoulder inactivity. eg post-surgery or injury.

If you do have a shoulder or arm injury, it is always advisable to seek the professional advice of someone such as your physiotherapist about exercises to help prevent a secondary frozen shoulder developing. This is especially important if you are in a high risk category.

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