Frozen Shoulder "Adhesive Capsulitis"

What is it?

Frozen shoulder is a condition that causes shoulder pain and limits the shoulder's range of motion. The limitation in movement affects both active and passive range of motion. That means that your movement is restricted at the shoulder joint both when you try to move your own arm and when someone else (such as your physio) tries to move your arm for you.

Mechanism of Injury

It often happens as a result of a shoulder injury (such as a rotator cuff tear), a bone fracture affecting the shoulder, or shoulder surgery. It can also happen after people have other types of surgery, such as heart or brain surgery.

Frozen shoulder can also happen without a preceding injury and tends to preferentially affect people with certain diseases and conditions. 

Frozen shoulder also seems to be more common among people with:

• Diabetes mellitus

• Diseases affecting the thyroid gland

• Prolonged immobilisation 

• Previous stroke

• Parkinson disease

• If you’ve taken antiretroviral medications (particularly medications called protease inhibitors) to treat HIV infection

• Experts do not know for sure what causes frozen shoulder, but they suspect it develops when the joint becomes inflamed and scar tissue forms. As this happens, the tissues inside the joint shrink and harden, making the shoulder harder to move.

People who have frozen shoulder often go through three phases of symptoms:

• First phase (2–9 months). Involves diffuse, severe, and disabling shoulder pain that is worse at night. The shoulder becomes increasingly stiff.

• Second phase (Intermediate) (4-12 months). The shoulder becomes very stiff and has limited mobility, but the pain gradually lessens.

• Third phase (Recovery) (5-24 months). People gradually regain range of motion.

The pain and stiffness it causes may seriously interfere with your ability to do everyday tasks, such as dress and bathe, or even work. Even once the pain of frozen shoulder starts to improve, the shoulder stiffness may still be quite limiting. For example, the condition might impede you from reaching overhead, to the side, or across your chest; or from rotating your arm all the way around from front to back. This could make it impossible for you to scratch your back or put on a jacket.

Common Management Techniques

• Heat and massage

• Analgesic balm (ie. Voltaren, Fisiocrem) 

• Deep tissue massage 

• Shoulder manipulation 

• Stretches

• Muscle energy techniques 

• Active release techniques 

• Dry Needling

• Education

• Postural education and programs 

• Pain Relief Medications prescribed by your GP, such as pain relief of anti-inflammatories can assist in reducing pain.

Prognosis

It is important to remember that recovery from Frozen shoulder is a slow recovery, lasting 9-12 months. Most people make a full recovery after this time, and only people who have had symptoms for a year or more and are not getting better should consider surgery.