Frozen Shoulder (Adhesive Capsulitis)

What is frozen shoulder?

It is a condition that leads to pain and stiffness of the shoulder. It’s also known as adhesive capsulitis or shoulder contracture.  The joint becomes painful and stiff, often without an apparent cause. The capsule becomes inflamed, which then seems to tighten up or shrink.

The tightening and pain restricts the movement.  The symptoms tend to gradually get worse over a number of months or years. You will typically experience shoulder pain for the first two to nine months, which can be severe, followed by increasing stiffness.  The condition may improve with time, but this can sometimes take several years. The ball is the top of the arm bone (Humerus) and the socket is part of the shoulder blade (Scapula). Around the joint is a loose, elastic bag or capsule. This is also supported by muscles and ligaments.

How is it diagnosed?

The main way Physiotherapists diagnose the problem is from an initial assessment carried out. This includes a consultation of asking you questions and examining your shoulder.

Why have I got a frozen shoulder?

The exact cause is unknown. However it is more common if you are aged between 40 and 70, and have diabetes or thyroid problems.  Some people link it to a minor shoulder strain or injury but often it can develop for no reason or from an extended period of not using your arm. Research is continuing to try and answer some of these questions.

How does it develop?

Frozen shoulder has three stages:

1. Painful stage – Can last between two and nine months. The pain often starts gradually and builds up. It can be worse when moving the arm, but also painful when at rest. Sleeping on the affected shoulder may be painful and impossible. The shoulder starts to become stiff.
2. Stiff stage – Can last between four and 12 months. The joint becomes increasingly stiff. Most people with frozen shoulder will eventually get better, even without treatment. However, appropriate treatment can help to reduce pain and improve the movement in your shoulder until it heals.

The type of treatment you receive will depend on how severe your frozen shoulder is and how far it has progressed especially on twisting movements, for example, putting your hand      behind your back. Even with help from the other hand these will remain stiff and tight. It is the ball and socket that are stiff and tight, not the shoulder blade which is still free to move, so you may notice it more. The pain should start to go during this stage.

3. Recovery stage – Can last between five and 26 months. There should be a reduced pain but the joint will still feel stiff. Your shoulder movement will start to increase during this stage and finally return to normal. It is important to remember that although the pain and stiffness are very limiting, usually the problem does resolve. On average it lasts between 12 and 42 months. As the recovery stage starts, you will find your movement slowly increases.

What treatment is there?

Most people with frozen shoulder will eventually get better, even without treatment. However, appropriate treatment can help to reduce pain and improve the movement in your shoulder During the painful stage, the emphasis is on pain relief. There are many different options such as injections, acupuncture, heat and ice. Some people find a transcutaneous electrical nerve stimulation (TENS) machine relieves their pain, however, its effectiveness in is based on individual experience rather than scientific evidence.

Once the initial pain has settled and the shoulder is stiff and tight, specific exercises to encourage the ball and socket joint to move will be advised. Sometimes, Physiotherapists will work on other areas around the shoulder such as your neck, shoulder blade and general  posture. This can help reduce pressure on the shoulder joint while it is in the stiff stage.

 Why can’t I get by hand behind my back yet?

This is one of the last movements to return. Raising your arm forward improves first. Don’t force movements if they are painful rather than stiff.

Keep moving

Once you have been shown some exercises your physiotherapist may not need to see you again, however it is essential to keep your shoulder moving and try to continue with a normal life as it takes some time to ease until it heals.