Frozen Shoulder

You may have heard someone say they have a 'frozen shoulder' - it's a fairly common condition affecting women more than men. It tends to affect the non-dominant shoulder more frequently, causing a gradual loss in the ability to move, accompanied by pain at certain stages.

Also called adhesive capsulitis, it occurs when the structures around the shoulder joint (capsule, tendons) become inflamed and adhered (stick to) each other.

Who can get a frozen shoulder?

Although it can occur in otherwise healthy individuals with no apparent reason, some conditions that increase the likelihood of having it are-

  • Diabetes
  • Parkinson's disease
  • Stroke
  • Shoulder injuries
  • Cancer
  • Thyroid disorders
  • Dupuytren's contracture (a condition affecting the hand)

What are the symptoms of a frozen shoulder?

  • It usually begins as a sudden onset of pain in one shoulder. Both shoulders being affected is rare. The pain is typically dull and aching all around the shoulder, especially on top. It may become sharper on movement, or be particularly bad at night.
  • This is followed by a gradual loss in the range of motion, first in external rotation (fastening a seatbelt), then abduction (moving arms up beside the body) and then flexion (reaching overhead).
  • There may be neck pain as a result of the neck muscles trying to compensate for a loss in shoulder mobility.

There are three stages to frozen shoulder, each lasting a couple of months-

  • The Freezing Stage: Almost any movement is painful, and the motion is just beginning to become restricted.
  • The Frozen Stage: Pain lessens, but the shoulder is very stiff and restricts activities.
  • Thawing Stage: Movements gradually become freer and easier.

Although a frozen shoulder can 'melt' or go away on its own, the pain is severe and the condition can greatly reduce your ability to bathe, dress and feed yourself, as well as complete work related tasks.

How is a frozen shoulder diagnosed?

Since there is no definite imaging or lab test, the diagnosis is based on what is seen on physical examination, such as loss of movement, pain, etc.

These symptoms can also be due to other conditions like a fracture or tendon tear, which is why it is important to be examined by a medical professional before beginning any exercise routine, instead of doing exercises that you find online.

What is the treatment for frozen shoulder?

  • Early stage adhesive capsulitis can typically be treated conservatively, with excellent results for both pain relief and range of motion.
  • Physiotherapy for frozen shoulder consists of using various modalities to reduce the pain, accompanied by mobilizations of the shoulder joint.
  • Mobilizations are skilled maneuvers performed on the joint to strategically stretch out the tight, restricting structures and thereby increase the range.
  • Mobilizations are accompanied by strengthening the muscles of the neck, upper back and shoulder, to make sure the arm has a stable base to support it as it moves through the newly gained range of motion.
  • Exercises for frozen shoulder are frequently given as a home program, that the patient does on their own in addition to treatment by the physiotherapist in person.
  • For cases that do not improve within six months of beginning non-surgical treatment, surgical options such as manipulation under anesthesia or capsular dilation may be considered; however, the majority of patients do not need this and recover well.