Frozen shoulder, correctly known as Adhesive Capsulitis, presents as a combination of shoulder pain and stiffness causing sleep disturbance and marked disability.
In a frozen shoulder the capsule surrounding the shoulder joint is more thickened than normal and it shrinks, adhering to the humerus (arm bone) and itself – hence the name adhesive capsulitis. It is associated with inflammation, causing pain followed by scarring, causing stiffness.
Clinical features of frozen shoulder
Gradual onset of arm pain.
Unable to lie on affected side.
Restriction of movements, usually into elevation and outward rotation.
Diagnosed by a thorough shoulder examination.
X-rays may rule out other causes of shoulder pain but are unable to diagnose a frozen shoulder.
Runs a distinct course which can be broken into 4 phases or simply “pain-predominant” and “stiffness-predominant”.
Phases of frozen shoulder
Phase 1: Usually pain.
Phase 2: Increasing pain and increasing stiffness but still predominantly pain.
Phase 3: Pain abates, leaving stiffness.
Phase 4: Resolution, usually by 2 years.
Who gets frozen shoulder?
Mostly occurs between ages 40 and 60 years.
More common in women and diabetics.
Often appears for no apparent reason but can stem from an injury to the shoulder or following shoulder surgery.
20% of patients will develop it in the other shoulder in the future but almost never occurs again in the same shoulder.
Common shoulder problems
Unable to: Reach above shoulder height
Throw a ball
Quickly reach for something
Reach behind your back e.g. doing up bra, tucking in shirt
Reach out to the side and behind e.g. reaching for seat belt
Sleep on your side
How can physiotherapy help?
Although a frozen shoulder is generally self-limiting, the aim of physiotherapy is to keep the shoulder joint as pain free and mobile as possible. Physiotherapy may also help reduce the time taken to move through each phase.
Phase 1 & 2- pain relieving techniques such as gentle mobilisation, muscle releases, dry needling, taping.
Phase 3- shoulder joint mobilisation and stretches, muscle release techniques, dry needling and exercises to regain range and strength. Treatment should not be too aggressive.
Phase 4- shoulder mobilisation and stretches followed by strength exercises to control and maintain the returning range of movement.