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Guide to Frozen Shoulder

What is a frozen shoulder?

What is a frozen shoulder?

Adhesive capsulitis also more commonly known as “frozen shoulder” is an ongoing and painful condition that affects the shoulder joint. It involves pain and stiffness that develops gradually, gets worse and then goes away. It can take anywhere from a year up to 3 years for it to go away. It always occurs in one shoulder and never in both at the same time. This condition has 4 stages to it:

  • Stage 1 is the “pre-cursor” phase that is characterised by achiness that becomes sharp at the end range of movement. There is a gradual onset of pain, no stiffness and no reduction in range of motion.
  • Stage 2 is the “painful”/ “Freezing” phase that is characterised by the gradual progression of a limited range of movement of the shoulder, constant pain and stiffness.
  • Stage 3 is the “frozen” stage, characterised by pain and a significant reduction in the range of motion of the shoulder joint. No pain at rest but pain on motion that is very limited and very stiff.
  • Stage 4 is the “thawing” stage, which is associated with a progressive reduction in pain and stiffness and an increase in the range of motion of the shoulder that may take up to 9 months.

As discussed above, the symptoms you may present with depends on what stage of the process you are at. However, these are some of the common signs and symptoms of frozen shoulder:

  • Pain and stiffness which are of gradual onset and are the main complaint
  • Reduction in the range of motion of the shoulder
  • Pain associated with shoulder movements that have become very limited
  • Stiffness that is getting worse
  • Difficulty in brushing hair, teeth or putting on clothing.

What causes a frozen shoulder?

It’s not clear why people develop this condition but some people are at a greater risk than others. It occurs more in females than males that are between the ages of 40 and 60. Your risk may increase if you have diabetes and other medical problems such as heart disease, thyroid disease or Parkinson’s.

How is a frozen shoulder diagnosed?

The diagnosis of frozen shoulder can be made by our practitioners who will conduct a thorough physical examination following a conversation about your signs and symptoms. They will assess your range of motion and perform specific tests that would help them determine at what stage you’re at and if it may be another condition that is mimicking the signs and symptoms of a frozen shoulder.

Your practitioner may also request imaging to rule out any other possible condition.

How is a frozen shoulder treated?

There is no single intervention that is significantly more effective than any other in terms of treatment. However several studies have shown varied outcomes on the effectiveness of manual therapy on improving range of motion, pain and function.

The aims of the treatment initially would be to help control pain and swelling. This would be carried out using manual techniques such as strengthening and stretching of the shoulder capsule.

If conservative management fails to provide you with relief the next stage in treatment would be injection therapy. Injections are very effective at reducing pain in the shoulder especially pain at night. The main role of the injection would be to reduce the amount of pain you’re in and hopefully improve your range of motion slightly and with the help of physical therapy to ensure that you make a full recovery.

References

Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. JBJS. 2000 Oct 1;82(10):1398.
Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of Shoulder and Elbow Surgery. 2004 Sep 1;13(5):499-502.
Kelley MJ, Mcclure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of orthopaedic & sports physical therapy. 2009 Feb;39(2):135-48.
Wu, W.T., Chang, K.V., Han, D.S., Chang, C.H., Yang, F.S. and Lin, C.P., 2017. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Scientific reports, 7(1), pp.1-12.

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