Frozen Shoulder (aka “Adhesive Capsulitis”) is a disorder that leads to loss of range of motion and persistent pain in the shoulder. Frozen Shoulder can lead to significant disability due to restraint on daily activity and disturbance of sleep. Symptoms typically worsen with time and resolve within eighteen months to three years. Frozen Shoulder is most common in people over the age of 40 and is more common in women than men.
Who is at risk?
Main risk factors for Frozen Shoulder are:
- Age: over 40
- Gender: over 2/3 of Frozen Shoulder patients are women
- History of recent injury/trauma: rotator cuff strains, shoulder surgeries and/or upper arm fractures etc.
- Diabetes patients: Frozen Shoulder develops in up to 20% of diabetes patients
Other health conditions such as thyroid disorders, cardiovascular disease, stroke and Parkinson’s disease can also increase the risk of Frozen Shoulder although the cause is unclear.
Symptoms
Symptoms of Frozen Shoulder include:
- loss of range of motion of shoulder in multiple directions
- pain with reaching overhead or pressure on shoulder
- constant ache during minimal shoulder movements
Individuals with Frozen Shoulder often report having trouble sleeping on the affected side, pain during office/computer work (using the mouse), and not able to reach higher cabinets, etc.
How do you get Frozen Shoulder?
The cause of Frozen Shoulder is not fully understood, however, it often begins with irritation or inflammation of the soft tissue structures around the shoulder, such as rotator cuff tendons or subacromial bursa. Irritation to these structures causes pain with movement, therefore limiting active range of motion.
When the shoulder is immobilized, the connective tissue around the shoulder joint (glenohumeral joint capsule) contracts and condenses over time. The surrounding muscles also become very tight (increase their tone) as a natural guarding response against perceived further injury. The combination of these events leads to progressive stiffening of the shoulder joint.
This increased stiffness can take up to eight to nine months to develop; this period is often called the “freezing phase”.
What should you do for Frozen Shoulder?
If you are noticing pain and restriction in your shoulder or are developing stiffness, see your doctor or physiotherapist for a physical examination. Frozen Shoulder can usually be diagnosed with a physical exam and by taking a thorough history of signs and symptoms. In some cases, clinicians may request imaging test (X-rays and/or an MRI) to rule out other conditions such as rotator cuff pathology or arthritic changes in the shoulder joint.
Frozen Shoulder Treatment
Treatment of Frozen Shoulder focuses on pain management in the early stage as well as regaining mobility and function of the shoulder. Your doctor may recommend nonsteroidal anti-inflammatory medication (NSAIDs) such as ibuprofen.
Heat packs or ice packs can also help with reducing pain, however, an ice pack may be more suitable if there is warmth in the shoulder area which would suggest possible inflammation. Heat, on the other hand, is more appropriate for muscle tightness/soreness around the shoulder and should be applied for up to 15min several times a day.
Corticosteroid injections are also an option to alleviate pain in severe cases, however, repeated corticosteroid injections are not recommended due to adverse effect to the tissues around the injection site. In rare cases where symptoms are particularly persistent, surgery is an option.
Non-Invasive Treatments for Frozen Shoulder
The most effective non-invasive treatment for Frozen Shoulder is therapeutic exercises concentrating on stretching of the joint capsule. The goal is to restore lost motion by stretching through active and passive movements.
A physiotherapist can provide an appropriate individualized exercise program with detailed instructions on how to complete each exercise, how often to perform them, and how far you should push yourself with each exercise.
The exercise program should also be performed at home and can be adjusted and progressed further as needed in the clinic. Joint mobilization techniques (where a clinician manually produces passive movement of a joint) have also shown to be effective in promoting active range of motion. Strengthening exercises will be incorporated once the range of movement has improved to restore proper function of the shoulder.
Note: Activities and positions that aggravate pain (lifting overhead, sleeping on the affected side etc) should be avoided during the process.
How long does it take to recover from Frozen Shoulder
Frozen Shoulder recovery may take a long time, and improvements might not be observed for weeks to months. However, 90 percent of the patients experience relief with treatment. The combination of pain management and diligently following the home exercise program will speed up your recovery timeline so it is important to stay positive, do your exercises, and avoid any extreme activities until fully recovered.
Next Steps
As mentioned above, If you are noticing pain and restriction in your shoulder or are developing stiffness, please see your doctor or contact one of our Trailside Physio locations and our team of experienced physiotherapists can help provide a proper diagnosis and treatment plan for you.