If you suffer from shoulder pain, you’re not alone. Rotator cuff tears and tendonitis are common culprits, but there could be a more complex issue at play. When shoulder movement is greatly restricted and simple actions like getting dressed become a daily challenge, it could be a sign you’re suffering from a condition known as Frozen Shoulder.
What is Frozen Shoulder?
Frozen Shoulder (Adhesive Capsulitis) is characterised by pain and a loss of movement in the shoulder joint, and is often accompanied by night-time pain that can impair your sleep. The condition occurs when the capsule surrounding the joint becomes inflamed and tightens up, causing pain and limiting your movement.
The initial presentation can mimic other conditions such as rotator tears, calcifying tendonitis and glenohumeral arthritis, but the one defining feature is a marked loss of passive range of motion, especially in rotation.
Three Phases of Frozen Shoulder
Frozen shoulder typically has three stages:
The Freezing stage – here pain starts to build up in the shoulder. It can be present at rest and worse with any movement. The range of movement starts to become reduced.
The Frozen stage – the shoulder becomes stiffer on all movements, especially rotating the joint, eg. putting your hand behind your back. The pain starts to reduce but is painful at the end of available motion.
The Thawing stage – there is no pain in the joint and range of movement gradually starts to improve.
Who does it affect?
Frozen shoulder is estimated to affect up to 5% of the population. Most common in those aged 40 to 60 years, it’s more prevalent in women. Those with diabetes are five times more likely to be affected than the general population.
Although the exact causes of Frozen Shoulder are unknown, people who have had a prolonged period of immobilisation can develop the condition, i.e after a broken arm, rotator cuff injury, post-surgery or stroke. It has also been found that people with certain systemic diseases such as diabetes, cardiovascular disease, tuberculosis, hyperthyroidism, hypothyroidism and Parkinson’s disease are at greater risk of developing frozen shoulder.
How to Prevent Frozen Shoulder
If you are facing the prospect of a prolonged period of immobilisation, you should consult your physiotherapist. Range of motion exercises can help maintain good passive range and prevent any capsular tightness and minimise the risk or a Frozen Shoulder.
How is it Treated?
Treatment in the early stages of the injury is aimed at pain relief. In order to increase the range of motion, massage of the musculature around the shoulder along with gentle range of motion exercises under guidance from your Physio can be effective. If pushed too hard this can be quite painful early on.
The best course of action to speed up recovery if conservative treatment is not working is to have a shoulder hydrodilatation. This procedure, performed by a radiologist, involves saline and some local anaesthetic being injected into the joint. This helps to break up the adhesions and distend the capsule, resulting in increased mobility. Depending on the severity of the frozen shoulder a second or third hydrodilatation may be required to restore full function.
If that does not work, another option is a MUA (Manipulation Under Anaesthetic) where the joint is forcefully extended to its end range motion, stretching the capsule and breaking up the adhesions.
It depends on the individual, but it can take from anywhere from 12 to 24 months to resolve fully. In no treatment is undertaken, full motion may not be recovered. It is quite uncommon, but Frozen Shoulder can recur, especially if the patient has diabetes. In up to 10% of cases it can go on to affect the other shoulder (the condition is typically unilateral).
If you suspect you may have the beginnings of Frozen Shoulder, call The Alignment Studio on (03) 9650 2220 today!
Pete Hunt is a highly skilled physiotherapist with nearly three decades of experience working in sports physiotherapy and private practice. The Director of The Alignment Studio, he has a special interest in musculoskeletal and sports injuries, orthopaedic rehabilitation and postural syndrome. With a caring, communicative approach, Pete uses a combination of joint and soft tissue mobilisation and exercise prescription to treat his clients. He’s also passionate about education for injury prevention and lasting results.