Articles Frozen Shoulder

September 8, 2019

This article explains what a frozen shoulder is, symptoms, causes, risk factors, diagnosis, medical and physiotherapy management.

Basic Anatomy

The ball of your upper arm bone connects to the socket of your shoulder blade to form the shoulder joint. 

Bones of the Shoulder Joint

Connecting the ball to the socket is a strong ligamentous joint capsule.

Joint Capsule

What is a Frozen Shoulder (aka Adhesive Capsulitis)?

A frozen shoulder is caused by shortening and stiffening of the joint capsule, this results in pain and a restriction of shoulder movement in all directions. Researches don’t quite fully understand why this occurs but many believe it is triggered by inflammation inside the joint capsule. 


Normal Vs Frozen Shoulder

This condition involves 3 overlapping stages: 

  • Stage 1 Freezing Phase, characterised by increasing pain and a progressive deterioration in movement 
  • Stage 2 Frozen Phase, characterised by an improvement of pain and marked joint stiffness in all directions
  • Stage 3 Thawing Phase, characterised by a gradual improvement in joint stiffness and shoulder movement
Stages of a Frozen Shoulder

Unfortunately, frozen shoulders typically take a long time to heal. Recovery times vary greatly between individuals (i.e. 6 – >24 months). The good news is this condition will gradually resolve itself and most people will make a full recovery.   

Most frozen shoulders will gradually resolve themselves

What are the Symptoms of a Frozen Shoulder?

  • restriction of shoulder movement in ALL directions
  • joint stiffness
  • shoulder pain (in the early stages)
  • difficultly with functional tasks (i.e. reaching behind your back, reaching behind your head)
Many shoulder injuries will only have restricted movement as the arm is raised towards shoulder height. A frozen shoulder will have restricted movement in ALL directions.

What Causes a Frozen Shoulder?

Spontaneous Onset 

Unfortunately, a frozen shoulder can occur out of the blue with no history of injury or trauma. This is more likely to occur in people who are high risk (see below). 

A frozen shoulder can spontaneously occur


Post Trauma

Trauma to the structures inside and surrounding the shoulder joint (i.e. fractures, rotator cuff tears).

Humerus Fracture

 
Post Surgery

Surgeries directly (i.e. rotator cuff repair) and indirectly (i.e. cardiothoracic surgery, breast surgery) affecting the shoulder joint .

Shoulder surgery


Prolonged Immobility 

Not moving your shoulder for prolonged periods of time (i.e. prolonged use of a shoulder sling).

Prolonged sling use

Risk Factors 

  • females 
  • 40-65 years of age 
  • heart and lung disease 
  • inflammatory conditions (i.e. rheumatoid arthritis)
  • diabetics 
  • stroke victims
  • hypo/hyper thyroidism
  • autoimmune disease
  • cervical disc degeneration
Frozen shoulders most commonly occur in people aged between 40-65 years of age

Diagnosis

Diagnosing this condition is mainly based on an individual’s clinical presentation through a thorough subjective and physical examination. An xray, ultrasound or MRI may also be required to exclude/identify other injuries.  

Typical movement pattern in people who have a frozen shoulder

Treatment

Most cases of frozen shoulder will gradually resolve on their own. Depending on what stage your shoulder is at, certain interventions can be beneficial in speeding up the recovery process. 

  • Conservative physiotherapy treatment is often the preferred treatment option (see below).
  • A cortisone injection into the joint capsule can help to reduce inflammation
  • A procedure called a hydrodilatation involves stretching out the joint capsule by injecting saline into it. This procedure is not very commonly used and studies have found it to be of only limited benefit.
  • Surgery is extremely rare and only reserved for those who have not made a full recovery despite comprehensive physiotherapy treatment. The procedure will normally involve surgically releasing the joint capsule and stretching the shoulder while under anaesthetic. 
A cortisone injection for a frozen shoulder shoulder be specifically administered into the joint capsule.

Physiotherapy Management

  1. Alleviate symptoms and decrease pain. Modalities such as strapping, massage, manual therapy and acupuncture may be used.
  2. Provide education, set realistic expectations, identify and modify aggravating factors
  3. Continually to reassess the shoulder for other injuries.
  4. Restore pain free shoulder range of motion
  5. Prevent secondary complications (i.e. neck and upper back pain)
  6. Strengthen the rotator cuff and muscles surrounding the shoulder blades.
This stretch helps to improve shoulder flexion

Please keep in mind the information provided is general in nature and should not be used as a substitute to consult your treating health professional. If you have any specific questions or require assistance with your individual treatment requirements please do not hesitate to contact MyFamily Physio in Pittwater Place Shopping Centre in Mona Vale.

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