Frozen Shoulder (Adhesive Capsulitis): Causes, Symptoms, and Treatment

What is Frozen Shoulder (Adhesive Capsulitis)?

Frozen shoulder occurs when the connective tissue surrounding the shoulder joint becomes inflamed and thickened, leading to scar tissue formation. The shoulder joint's range of motion becomes severely restricted as a result. The condition often progresses in three stages:

1. Freezing (Painful) Stage:

   • This stage typically lasts 6 weeks to 9 months.

   • Pain begins gradually, especially with shoulder movement. As the pain worsens, the range of motion becomes limited.

2. Frozen Stage:

   • The pain may decrease, but stiffness becomes more pronounced.

   • The shoulder is very stiff, and using the arm becomes difficult, lasting from 4 to 6 months.

3. Thawing (Recovery) Stage:

   • This stage can last anywhere from 6 months to 2 years.

   • Gradual improvement occurs in shoulder mobility, and the stiffness and pain decrease.

Causes of Frozen Shoulder

The exact cause of adhesive capsulitis is not always clear, but several factors and conditions can increase the likelihood of developing the condition:

1. Injury or Surgery

• Shoulder injuries, surgeries, or fractures can lead to stiffness and reduced mobility, potentially contributing to frozen shoulder. Immobility during the recovery period after surgery can lead to a gradual stiffening of the joint capsule.

2. Chronic Health Conditions

Certain medical conditions are linked to a higher risk of frozen shoulder:

• Diabetes: People with diabetes are more likely to develop frozen shoulder. The exact reason is unknown, but it may be related to changes in connective tissue caused by blood sugar levels.

• Thyroid disorders: Hypothyroidism (underactive thyroid) is another condition often associated with frozen shoulder.

• Heart disease: People who have had a heart attack or cardiovascular surgery may be more prone to frozen shoulder.

• Parkinson’s disease: This condition can lead to stiffness in the joints, increasing the risk of developing frozen shoulder.

3. Age and Gender

• Frozen shoulder typically affects people between the ages of 40 and 60, and it is more common in women than men.

4. Immobilization

• Prolonged lack of movement due to an injury, surgery, or illness can lead to the development of frozen shoulder. The longer the shoulder remains immobile, the higher the risk of developing stiffness and adhesive capsulitis.

Symptoms of Frozen Shoulder

The hallmark symptoms of frozen shoulder include:

1. Pain:

• Pain is typically felt in the outer shoulder or upper arm. It can be severe at first, especially with movement, and gradually becomes more constant over time.

2. Stiffness:

• A significant decrease in shoulder mobility is a key symptom. Activities such as reaching behind your back, lifting your arm overhead, or rotating your arm can become difficult or impossible.

3. Limited Range of Motion:

• One of the defining characteristics of frozen shoulder is the inability to move the shoulder through its full range of motion due to stiffness and pain.

4. Night Pain:

• Many people with frozen shoulder report increased pain at night, which can disrupt sleep.

5. Gradual Progression:

• The symptoms tend to develop slowly, beginning with mild discomfort, progressing to severe pain, and eventually, loss of movement.

Diagnosing Frozen Shoulder

A healthcare provider typically diagnoses frozen shoulder based on a combination of clinical examination, medical history, and imaging tests.

1. Physical Examination:

• The doctor will check for restricted movement and tenderness in the shoulder joint. They will assess both active and passive range of motion (i.e., moving the arm both voluntarily and with assistance).

2. Imaging Tests:

• X-rays: Although frozen shoulder does not show up on X-rays, they can help rule out other potential causes of shoulder pain, such as arthritis or fractures.

• MRI: An MRI can provide more detailed images of soft tissue, helping to confirm the presence of thickening of the shoulder capsule and inflammation.

• Ultrasound: This can help identify changes in soft tissue around the shoulder and rule out other conditions.

Treatment for Frozen Shoulder

Treatment for frozen shoulder focuses on relieving pain and improving mobility. The exact treatment plan depends on the stage of the condition and its severity.

Non-Surgical Treatment

1. Pain Management:

   • NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like ibuprofen can help reduce pain and inflammation.

   • Corticosteroid Injections: Injections into the shoulder joint can provide temporary relief from pain and inflammation.

2. Physical Therapy:

   • Physical therapy is essential for restoring movement and reducing stiffness in the shoulder. A therapist will guide you through stretching and strengthening exercises to improve mobility.

   • Passive Stretches: The therapist may help stretch the shoulder to improve flexibility.

   • Strengthening Exercises: After the initial pain decreases, exercises to strengthen the shoulder muscles and prevent re-injury are essential.

3. Heat or Cold Therapy:

   • Applying heat or cold packs can reduce pain and stiffness in the shoulder. Cold packs help reduce inflammation, while heat may relax tense muscles.

4. Transcutaneous Electrical Nerve Stimulation (TENS):

   • TENS units use electrical impulses to reduce pain and help improve range of motion by stimulating the nerves in the shoulder.

5. Joint Mobilization:

   • A physiotherapist or healthcare provider may use gentle techniques to mobilize the shoulder joint and restore movement.

Surgical Treatment

If non-surgical treatments do not improve the symptoms after a prolonged period, or if the frozen shoulder is particularly severe, surgical intervention may be considered.

1. Manipulation Under Anesthesia (MUA):

   • In this procedure, the shoulder is moved forcibly while the patient is under anesthesia. This technique can help break up the scar tissue and restore range of motion.

2. Arthroscopic Surgery:

   • In some cases, surgery may be needed to remove thickened tissue from the shoulder capsule. This is done through a minimally invasive procedure with small incisions.

Recovery and Rehabilitation

Recovery from frozen shoulder can be a slow and gradual process. Even with treatment, it can take months to years to regain full shoulder function.

• Physical Therapy: Continual therapy is crucial during the recovery phase to restore mobility, strength, and function.

• Post-Surgery Rehab: If surgery is performed, rehabilitation is essential to prevent recurrence of stiffness and ensure the shoulder heals properly.

• Patience and Consistency: The recovery process may be frustrating, but consistent treatment and rehabilitation efforts are key to improving shoulder function over time.

Prevention of Frozen Shoulder

While frozen shoulder can’t always be prevented, the following tips may reduce the risk:

1. Stay Active: Regular exercise, particularly shoulder stretches and strengthening, can help maintain joint mobility and prevent stiffness.

2. Avoid Prolonged Immobility: After shoulder surgery or injury, gently moving and stretching the shoulder as directed by a healthcare provider can prevent frozen shoulder.

3. Treat Underlying Conditions: Managing conditions like diabetes or thyroid issues may reduce the risk of developing frozen shoulder.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our expert physiotherapists specialize in the treatment and rehabilitation of frozen shoulder. Whether you’re in the painful, frozen, or thawing stage, we provide personalized treatment plans to improve your shoulder mobility and reduce pain. If you're experiencing symptoms of frozen shoulder, contact us today for a comprehensive assessment and treatment plan.