Frozen shoulder or ‘adhesive capsulitis’ is a condition that can be disabling and sometimes severely painful. It is characterised by stiffness and pain in the shoulder joint, where signs and symptoms begin gradually and worsen over time. Pain often takes 1 to 3 years to develop.
The bones, ligaments, and tendons that make up the shoulder are encased in a capsule of connective tissue. The frozen shoulder disorder occurs when the capsule and tissue surrounding it becomes thickened and stiff, causing a restriction of motion and pain.
Causes of frozen shoulder can be difficult to pinpoint and can range from injury, excessive use or immobilisation of the shoulder along with post-surgery. Frozen shoulder was previously thought to be a result of autoimmune or inflammatory disorders; however, this theory is established to be untrue and no relation has been proven. It has been found that people over 40, women and people who have diabetes can be more susceptible to frozen shoulder. Other diseases that may increase the risk of frozen shoulder include cardiovascular disease, tuberculosis, and Parkinson’s disease.
Frozen shoulder typically develops in 3 stages that can last a number of months each. The stages of frozen shoulder include the freezing stage, frozen stage and thawing stage. The freezing stage involves pain during movement of the shoulder and shoulder movement beings to become limited. During the frozen stage, the shoulder pain begins to diminish, however movement is difficult as the shoulder stiffens. Using the shoulder may become more difficult during this stage. The final stage is the thawing stage. During this stage the range of movement and motion in the shoulder begins to improve and there is no longer any pain.
During the painful stages of frozen shoulder, pain can worsen at night and can disrupt a person’s sleep. Cold weather can also irritate frozen shoulder and worsen symptoms.
Treatment usually consists of pain relief and physical therapy that can help improve movement and muscle function.
Heat can be used to loosen the shoulder and reduce pain at home. Over the counter pain medications can also be useful when managing frozen shoulder pain at home. Pain killers are useful and can help reduce discomfort, however anti-inflammatory drugs usually do not provide any benefit as the condition is not an inflammatory condition.
Pain relief gels, creams and rubs can also be useful but should not be used in conjunction with over the counter pain killer pills as the medications interact.
When Should I See My Physiotherapist?
It is important to contact your physiotherapist as soon as you have signs of a painful or restricted shoulder. Frozen shoulder can resolve on its own, however in rare cases it can be more than 2 years before symptoms begin to fade. Our physiotherapists will be able to aid in proper diagnosis of frozen shoulder and provide the appropriate treatment. This includes prescribed exercises, stretches and pain relief.
Stretching exercises are very important during all stages of frozen shoulder, however a plan should be developed by your physiotherapist to cater for your needs. Strengthening exercises will also aid in the prevention of muscle strength and mass loss. Once again, these exercises will need to be prescribed by your physiotherapist in order to adjust for your symptoms, pain level and to prevent injury.
Your physiotherapist may also suggest heat or other treatments for pain relief.
Advice on preventing frozen shoulder in the future can also be provided from your physiotherapist.
If symptoms and pain persists, your physiotherapist will be able to refer you to a specialist for other treatments which may include injections or surgery.