Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is initially characterised by an initial onset of pain in the shoulder which may radiate down the arm, with progressive loss of range of movement. The cause for frozen shoulder can either can occur as either primary (where the symptoms occur without cause) or secondary where it occurs following trauma or surgery.

Frozen shoulders are more prevalent in women, those ages between 40-65, those with diabetes and occurs in approx. 2-5% of the general population. Other risk factors may include trauma, prolonged immobilisation, thyroid disease, stroke, myocardial infarcts or auto immune diseases.

While frozen shoulder typically only affects one shoulder, those who diagnosed do have an increased risk of developing a frozen shoulder in their other shoulder at some point.

Symptoms

Frozen shoulder typically begins with an insidious onset of pain with a progressive loss of range of movement resulting in difficulty in performing overhead activities such as washing and dressing. It has been documented that there are typically 3 stages to a frozen shoulder:

1)    ‘Freezing’ stage: Gradual onset of shoulder pain at rest and sharp pain towards end of movement. May gradually radiate down the arm. Pain at night which may interrupt sleep but no significant decrease on shoulder range of movement. This can last anywhere between 3-9 months.
2)    ‘Frozen’ stage: Pain begins to reduce however there is a noticeable reduction in range of movement. Typically this lasts from 4-12 months
3)    ‘Thawing Phase’: Little pain present, with some progressive improvement in functional range of movement which can last from 1-3 years. In some instances, full range may never return.

Diagnosis

Frozen shoulder can often present as other potential diagnoses, however with a detailed and thorough subjective and objective assessment from a physiotherapist, a more accurate conclusion of frozen shoulder can be identified. Historically it has been viewed that a frozen shoulder has a 'capsular pattern' (loss of certain movements in a certain order) with loss of external rotation first, then shoulder abduction then shoulder internal rotation.

How Can Physiotherapy Help?

Once a diagnosis has been made, there are a number of treatments that physiotherapists can provide. Typically these include:

•    Education and advice
•    Gentle range of movement exercises
•    Passive range of movement exercises
•    Mobilisation
•    Stretched
•    Graded strength programme
•    Acupuncture
•    Pain relieving modalities