Article by John Miller
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, it has a distinct pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness.
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 about Frozen Shoulder?
Frozen shoulder causes your shoulder joint capsule to shrink, which leads to pain and reduced range of shoulder movement. Your shoulder capsule is the deepest layer of soft tissue around your shoulder joint, and plays a major role in keeping your humerus within the shoulder socket.
What are Frozen Shoulder Symptoms?
Frozen shoulder has three stages, each of which has different symptoms.
The 3 Stages are:
1.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.
2.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.
3.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 can last on average 6 to 8 months if left untreated.
How is Frozen Shoulder Diagnosed?
Frozen shoulder can be diagnosed in the clinic from your clinical signs and symptoms.
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.
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 shoulder practitioner assessing you.
Frozen shoulder is commonly misdiagnosed or confused with rotator cuff injury by inexperienced shoulder practitioners. It is important to get an accurate diagnosis since the treatment and recovery vary considerably.
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 rotator cuff 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.
Who is Likely to Suffer 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.
◾inactivity of the shoulder,
◾cervical cancer, and
Approximately 20% of people who have had a frozen shoulder will also develop frozen shoulder in their other shoulder in the future.
Frozen Shoulder Treatment
Physiotherapy treatment for frozen shoulder depends on what stage you are in, and is tailored to your specific needs.
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.
It is important not to aggravate a frozen shoulder during this phase, which is unfortunately a side effect of an overzealous practitioner.
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.
Overenthusiastic treatment can aggravate your capsular synovitis and subsequently pain. A quality shoulder physiotherapist will know how much is enough and how much is too much.
Shoulder mobilisation and stretches are your best chance of a prompt return to full shoulder movement. As your range of motion increases your physiotherapist will be able to provide you with strengthening exercises to control and maintain your newly found range of movement.
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 shoulder injury.
If you do have a shoulder or arm injury, it is always advisable to seek the professional advice of someone such as your shoulder physiotherapist about exercises to help prevent a secondary frozen shoulder developing. This is especially important if you are in a high risk category.
For more information, please contact your physiotherapist