Adhesive Capsulitis – Frozen Shoulder

rotatorcuff tendonitis

What is Frozen Shoulder?

While often referred to as frozen shoulder, the accurate term for the condition is adhesive capsulitis. Frozen shoulder is an inflammatory condition that affects 3-5% of the population. Increased adhesions and thickening of the joint capsule cause the shoulder to stiffen. The stiffening can be very painful, and will cause reduced range of motion in the affected shoulder. The progression of frozen shoulder often lasts 24 months and follows a general timeline through each phase. 

There is a primary and secondary frozen shoulder. Primary frozen shoulder is caused spontaneously with progressive and painful loss of shoulder motion. Secondary frozen shoulder can be caused by trauma (e.g. surgery), disease (e.g. diabetes) or neurological condition (e.g. stroke). 

Progression of Frozen Shoulder

There are 4 stages of frozen shoulder, which include:

Stage 1: Inflammatory Phase

General aching pain around the shoulder and increased pain with movement lasting for up to 3 months.

Stage 2: Freezing Phase

Pain that is constant in the shoulder, even without movement. Shoulder joint becomes increasingly stiff. This phase will last for 3 to 9 months.

Stage 3: Frozen Phase

Pain continues to be present but begins to decrease. Shoulder continues to increase in stiffness, and there is a decrease in shoulder range of motion. May begin to notice the muscle bulk reduces from lack of movement. This phase will last 9 to 15 months.

Stage 4: Thawing Phase

Pain is at a minimum; stiffness is reducing and shoulder range of motion and function begin to improve. 

Diagnosis

Due to the nature of frozen shoulder, it is difficult to diagnose in the early stages because it presents similar to other common shoulder injuries such as rotator cuff tendinopathies. A thorough history and examination alongside worsening mobility and increased pain is how frozen shoulder would typically be diagnosed.  

Management

Education: This is the most important aspect of rehabilitation for clients dealing with a frozen shoulder. The spontaneous nature of the condition, progressive pain and reduction in mobility caused by a frozen shoulder can be very frustrating and debilitating. We educate all our clients on what to expect and how they can have autonomy in their rehab.

Improve/maintain range of motion: During the freezing and frozen stage, we encourage maintaining range of motion, and moving the shoulder through pain-free ranges, as tolerated. During the thawing stage, we will work to improve mobility as much as possible. 

Maintain muscle activity: During the freezing and frozen stage, we want to encourage maintaining as much strength as possible, typically through isometric exercises. During the thawing stage we will push to improve strength.  

FAQs:

  1. What is the fastest way to get rid of frozen shoulder? Unfortunately, with a true bout of frozen shoulder there is no quick fix and will last 12-24 months. However, with effective education and management, symptoms can be reduced and return to normal function will be quicker.
  2. Can a frozen shoulder go away on its own? If left untreated a frozen shoulder will resolve on its own but you may have strength and range of motion limitations.
  3. What are the stages of frozen shoulder?
    • Inflammatory phase
    • Freezing phase
    • Frozen phase
    • Thawing phase

DO YOU THINK YOU HAVE FROZEN SHOULDER?

Contact us and we can arrange for a Free Consultation with one of our Physiotherapists to speak with you about your individual case.

  

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