As the name suggests, Frozen Shoulder (also known as Adhesive Capsulitis) is a condition where the shoulder joint becomes stiff (“frozen”) and is often painful.
The shoulder joint is the most mobile joint in our body and is surrounded by a capsule, ligaments and muscles to keep it stable. This condition can occur spontaneously with no apparent cause (Idiopathic Frozen Shoulder) or can occur after shoulder injury (Secondary Frozen Shoulder). Females, individuals over 40 years old and those with diabetes are more prone to this condition.
In a frozen shoulder, the shoulder capsule and ligaments become inflamed and contracted, causing pain and the characteristic loss of range in motion both actively and passively. Pain is often diffused in the shoulder region and night pain that disturbs sleep is a characteristic feature of this condition. Activities like washing your hair, cleaning your back or lifting up your shirt overhead becomes increasingly difficult. The symptoms of frozen shoulder can be described in 4 stages (Neviaser & Neviaser, 2011):
- Stage 1: Shoulder pain at end of range movements, presence of night pain. Shoulder range relatively intact although there may be some reduction in external rotation (shoulder turning outwards away from body). This stage may last for 3 months.
- Stage 2 (“freezing” stage): Increasingly severe shoulder pain with further loss of shoulder range in most directions. This stage may last for 3-9 months.
- Stage 3 (“frozen” stages): Less severe pain but shoulder range is markedly reduced. This stage may last for 9 to 15 months.
- Stage 4 (“thawing” stage): Pain starts to resolve and range slowly improves.
Clinical assessment will show loss of shoulder range both actively and passively. The shoulder joint will feel stiff on manual assessment and your physiotherapist will also perform tests to rule out other shoulder pathologies. Imaging is usually not required for a diagnosis of Frozen Shoulder, but your physiotherapist may refer you for imaging to rule out other significant shoulder pathologies if they suspect so.
Clinical guidelines by the American Physical Therapy Association (Kelley et al., 2013) recommend the following physiotherapy management for frozen shoulder:
- In the early stages of inflammation and pain, emphasis is on pain and inflammation control. Gentle manual therapy or electrical modalities can be used for pain management. Aggressive manual therapy is not recommended in this stage as it may worsen symptoms. Pain medication and anti-inflammatories may be required and corticosteroid injections can also be considered. Your physiotherapist will advise you on how to modify your activities and teach you appropriate ranging exercises to prevent aggravating your symptoms.
- As pain lessens, more aggressive manual therapy may be used and your physiotherapist will progress your exercises to help improve your shoulder range. Electrical modalities can continue to be used if they provide good pain relief.
Frozen shoulder may take up to 2-3 years to resolve and most individuals will be able to return to normal activities with physiotherapy treatment. However, mild symptoms may still persist and a small group of individuals may have some residual limitations.