Chiswick-Physio BLOG

Frozen Shoulder
Shoulder

What is a Frozen Shoulder?

Medically known as adhesive capsulitis

Frozen Shoulder is a common cause of shoulder pain associated with restricted active and passive range of motion. Frozen Shoulder has often been described as a self-limiting condition, with recovery within two to three years for the majority of patients. However, symptoms of mild to moderate pain and stiffness are reported in 27–50% of patients at long term.

The term Frozen Shoulder is an inaccurate description of what actually occurs within the shoulder. It would be more accurate to refer to the shoulder as a stiff or sticky painful shoulder, as stiffness and reduced range of motion are evident. Furthermore, it is inaccurate to refer to the condition as adhesive capsulitis since there are no adhesions formed within the shoulder.

We’ve been using these old terms to describe the condition in light of the fact that we now have a lot more knowledge about it than ever before.

How Does A Frozen Shoulder Form?

At this stage, there is no simple answer to this question, since we don’t have all the answers. But, fortunately we do have some ideas of the process occurring inside the shoulder joint.

Early on, inflammation is the main driver of the condition, which leads to a cascade of effects within the shoulder capsule. This leads to the common characterized appearance of thickening of the anterior capsule of the shoulder joint, which restricts shoulder mobility.

Medically speaking (If you’re interested)

Specifically the coracohumeral ligament and middle glenohumeral ligament are two of the anterior shoulder ligaments that commonly thicken.

You can visualize how this process works by imagining the ball and socket of your shoulder being held together by a strong, interwoven mesh material (the capsule). The capsule normally provides adequate shoulder support and space. When a frozen shoulder occurs, the shoulder capsule becomes thick, reducing the space between it and the shoulder.

What Causes A Frozen Shoulder?

The stiff shoulder is classified into the primary idiopathic stiff shoulder (frozen shoulder) and secondary stiff shoulder.

Primary idiopathic stiff shoulder refers to a stiff shoulder that develops without any specific trauma or underlying condition. There is the possibility that the patient may have a condition that is linked to stiffness (e.g., diabetes, thyroid disorders), but not necessarily one that causes stiffness.

In secondary stiffness, the shoulder is described as being stiff from an underlying cause like trauma, infection, or inflammation. The prevalence of frozen shoulder is estimated to affect 2–5% of the population.

How Is A Frozen Shoulder Diagnosed?

Most often, a practitioner who is your first point of contact will be able to diagnose the problem. Commonly, this includes the GP, the physiotherapist, the consultant, and other health practitioners with experience in treating shoulder conditions. The practitioner will use the following criteria to help inform their decision during the consultation.

  • Age and Sex:

    • More common in females than males

    • Between 40-60 years of age.

  • Loss of Range of Motion:

    • Loss of outward rotation at the shoulder both actively and passively in comparison to the non-affected side,

    • Loss of the ability to lift the arm out to the side both actively and passively.

  • Pain:

    • Initially, constant, throbbing pain, severe in nature often causing sleep disturbance.

    • Pain is sharp with movement and when pushing towards the end range of motion.

What Are The Stages Of Frozen Shoulder?

Commonly there are three stages of the Frozen Shoulder that are discussed within the literature. These stages have come under some scrutiny in the past, as they aren’t as clear-cut as they appear. However, these three stages can be a useful guide to understanding changes in symptoms that occur commonly.

  1. Pain predominant = Lasting around 2-6 months. Associated with constant pain and reduced range of motion.

  2. Stiff predominant = Lasting between 4- 12 months. Associated with pain at the end range of movement and a feeling of stiffness.

  3. Thawing = Lasting between 6-26 months. Associated with less pain and a slow improvement in range of motion and stiffness.

Many people experience living with a condition in very different ways, so some symptoms may resemble the ones listed above while others may be unique to them.

     

    How Is A Frozen Shoulder Treated And Managed?

    Pain Predominant Stage

    This stage of treatment should be aimed at minimizing pain. Many options are used to alleviate pain, such as nonsteroidal anti-inflammatories, steroids (local or oral), and pain-relieving physiotherapy.

    It should be emphasized that none of these measures will eliminate the pain completely. Rather, the entire activity of pain minimization aims to help you perform activities of daily living more easily, sleep better, and ease into physiotherapy.

    Stiff Predominant Stage

    Through an effective and well-structured physiotherapy program, the primary goal of treatment should be to gradually restore range of motion.

    Hydrodilatation could also be used as an adjunct in early frozen stages to accelerate the recovery.

    Thawing Stage

    In this stage, you experience minimal pain and gradually improve your range of motion for at least several weeks. Physiotherapy, therefore, remains the mainstay of the treatment in this stage in order to gradually restore the ‘functionality’ of the shoulder followed by total recovery.

    We are here for you

    If you’re in pain and would like to talk to us about getting some help, some specialist advice, or if you are looking for a diagnosis, remember we are always here to help you.

    Appointments remain limited and we are experiencing an exceptionally high demand for our physio services since UK restrictions were lifted, so please contact us immediately to avoid a long wait.

    If you would like to get one of our limited slots, please click HERE to email or CALL us on 07900603617.

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