Treating frozen shoulder

Frozen shoulder (technically called Adhesive Capsulitis) is a condition that causes pain and loss of motion in the shoulder joint. It can affect all aspects of a person’s life, limiting their ability to work and enjoy life.

Causes of frozen shoulder

No one really understands why some people develop a frozen shoulder. Normally, the shoulder joint allows more motion than any other joint in the body. When frozen shoulder occurs the capsule that surround the joint contracts. The capsule also forms bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the shoulder to become stiff and movement to become painful.

Frozen shoulder most commonly affects individuals between the ages of 40 and 60 years, and it is twice more common in women than in men. Certain hormone related problems such as thyroid problems or diabetes can increase the risk of developing frozen shoulder.

Diagnosing frozen shoulder

A frozen shoulder causes a typical set of symptoms that can be identified by your health care provider. The most important finding is restricted movement. However, other shoulder conditions can cause difficulty with movement of the shoulder, and can mimic a frozen shoulder. Therefore it is important to see an examiner familiar with this condition for a proper diagnosis.

The most common complaint with a frozen shoulder is of a dull aching pain, and limited shoulder mobility. In some cases, mobility may decrease so much that performing everyday activities – such as combing your hair, brushing your teeth or reaching for your wallet in your back pocket – is difficult or even impossible.

Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. An X-ray is usually obtained to ensure the shoulder joint appears normal, and there is no evidence of injury to the joint. An MRI is sometimes performed if the diagnosis is in question, but this test is better at looking for other problems, rather than looking for frozen shoulder.

Stages of frozen shoulder

There are three stages of frozen shoulder. Each can last for several months, and each has a typical presentation.

Painful/freezing stage

This is the most painful stage of a frozen shoulder, and is the acute inflamed stage. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts one to three months.

Frozen stage

During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last four to six months.

Thawing stage
The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

Treatment

The proper treatment of frozen shoulder can be a very controversial issue. There is argument regarding the type, frequency and intensity of treatment for this condition. What is not controversial is that frozen shoulder is a very difficult condition to treat.

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible to permit the performance of everyday tasks.

Ideally, therapy will help to maintain as much mobility in the shoulder as possible, without stressing the shoulder to the point of causing a lot of pain. Continue to use the involved shoulder and arm in as many daily life activities as possible within the limits of pain and range of motion constraints.

Gently and gradually moving the shoulder through range of motion exercises won’t completely alleviate the symptoms of frozen shoulder. However, it may help restore enough shoulder motion to enable resumption of everyday activities.

The initial freezing stage is the most difficult phase to treat. Treatments that may be effective in the latter stages will provide only slight temporary benefit during the painful freezing stage. Generally, the first stage of frozen shoulder responds best to pain medication and the recommendation to use the arm as much as possible within pain tolerance.

Treatment for frozen shoulder is varied, and includes a wide variety of practitioners. Many patients find benefit with a combination of medical, chiropractic and physiotherapy treatments.

Common treatment for frozen shoulder include: manipulation, cortisone injections, anti-inflammatory medications, heat/ice, ultrasound and acupuncture. Further, a home care programme of self-stretching, assisted stretching, and exercise is important.

Recovery

Most patients who have a frozen shoulder will have slight limitations in shoulder motion, even years after the condition resolves. However, the vast majority of patients who develop a frozen shoulder will recover their prior activity level and lifestyle.

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