Understanding Frozen Shoulder: Symptoms, Risk Factors, and Treatment

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. In this basic guide, we will delve into the symptoms, risk factors, stages, and treatment options for frozen shoulder to help you better understand and manage this condition.

Recognizing Frozen Shoulder

Frozen shoulder usually starts with mild pain and stiffness that progressively worsen over time. The pain is often described as a dull, aching sensation that radiates throughout the shoulder area, particularly around the deltoid muscle. It tends to intensify at night, leading to sleep disturbances, especially for individuals who typically sleep on the affected side.

Alongside pain, a significant limitation in shoulder movement becomes noticeable. Activities like raising your arm to the side (abduction), rotating your arm away from your body (external rotation), and rotating your arm towards your body (internal rotation) become increasingly difficult. In the early stages, you may find it challenging to raise your arm to the side to shoulder height or to rotate your arm towards or away from your body.

As the shoulder joint “freezes,” the stiffness becomes more pronounced, making routine tasks like reaching for items on high shelves or fastening a bra particularly challenging. Over time, muscle atrophy may occur, resulting in a decrease in shoulder strength.

If you experience a combination of these symptoms, it is recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan. A physiotherapist can complete a thorough assessment to assess the location and sources of your pain as well as measure your range of motion and get you started on a home exercise plan. 

Stages and Duration of Frozen Shoulder

The progression of frozen shoulder can be likened to the changing seasons. It typically evolves through three stages: the “freezing” phase, the “frozen” phase, and the “thawing” phase.

During the “freezing” phase, pain sets in, and shoulder movement gradually becomes restricted over a period of 10 to 36 weeks. The “frozen” phase follows, lasting anywhere from 4 to 12 months. In this stage, the shoulder joint becomes significantly stiffer, but the pain may start to diminish. Finally, the “thawing” phase begins, characterized by a gradual return of shoulder mobility, which can take up to 26 months. The entire duration of frozen shoulder can range from 1 to 3.5 years, with an average duration of about 30 months. It’s important to note that individual experiences may vary.

What Triggers Frozen Shoulder

While the exact cause of frozen shoulder is not fully understood, it is often associated with a prolonged period of shoulder immobility. Common triggers include post-surgery recovery, arm immobilization due to injury, or even prolonged bed rest. Researchers believe that an inflammatory process within the shoulder’s capsule leads to swelling and stiffness. Minor injuries to the shoulder tendons may contribute to this inflammatory response, although the precise initiators are still under investigation.

Physiotherapy Approach to Frozen Shoulder: Treatment and Exercises

When it comes to treating frozen shoulder, physiotherapy plays a vital role in restoring movement, reducing pain, and regaining overall shoulder function. Let’s explore the treatment approach and exercises involved in physiotherapy for frozen shoulder.

General Treatment Approach

The treatment approach for frozen shoulder may vary depending on the stage of the condition. In the initial stages, a conservative approach is typically adopted, which includes patient education, massage, acupuncture, and possibly use of modalities such as ultrasound. These treatments are often combined with end-range glenohumeral (GH) joint mobilizations and therapeutic stretching exercises. Your physician may advise corticosteroid injections to manage pain effectively or hydrodilatation to decrease pain and improve range of motion. 

Exercise Examples

Exercise forms the cornerstone of physiotherapy for frozen shoulder. A gradual, phased approach is essential to avoid exacerbating symptoms. The exercises typically progress from Active-Assisted Range of Motion (AAROM) exercises to Active Range of Motion (AROM) exercises, couple with resistance exercises to maintain strength.

Here are some examples of early AAROM exercises that your physiotherapist may recommend.

– Wand Exercise: With this exercise, you use a stick to assist the affected arm’s motion. It can help improve flexion, abduction, and scaption without working into pain.

– Pulley Exercise: This exercise requires a pulley system. By using the unaffected arm, you assist the movement of the affected arm into varying degrees of abduction and flexion. These exercises are active assisted range of motion and similar to the wand exercises.

– Pendulum Exercise: Visualize your arm as a pendulum, swinging freely. This exercise is beneficial in the early stages when range of motion is limited. Your arm moves in different planes to improve flexibility, and you can optionally use a weight for added resistance.

Manual Therapy

Manual therapy techniques can provide an extra boost in regaining shoulder range of motion. This therapy involves end-range mobilization of the glenohumeral (GH) and scapulothoracic (ST) joints, as well as capsular stretching. Joint mobilizations are performed in different directions to enhance mobility effectively.

While frozen shoulder may begin to feel like an endless winter, a comprehensive physiotherapy approach, such as the one provided by Connect Physiotherapy & Exercise, can help you regain normal shoulder function and get back to living an active life. The experienced team at Connect Physiotherapy & Exercise will work closely with you to develop a personalized treatment plan tailored to your specific needs and condition. This plan will incorporate patient education, therapeutic exercises, manual therapy techniques, and the appropriate use of modalities. By partnering with Connect Physiotherapy & Exercise, you can benefit from their expertise, guidance, and support throughout your frozen shoulder recovery journey, ensuring you return to a normal shoulder and enjoy an active and fulfilling lifestyle.

*Remember, while knowledge is power, self-diagnosis and treatment can be risky. While this blog provides useful information, it’s essential to see a trained professional for proper diagnosis and management. Every person is unique, and so is their recovery journey. At Connect Physiotherapy & Exercise, we’re all about personalized care. Let us help you navigate your path to recovery.

References

Tamil k., Akutsu M., Yano Y. (2014). Primary frozen shoulder: brief review of pathology and imaging abnormalities. Journal of Orthopedic Science, 19(1), 1-5. (S1,S3)

Siegel, L.B., Cohen, N.J., Gall, E.P. (1999). Adhesive capsulitis: a sticky issue. American Family Physician, 59(7), 1843.

Ewald A. (2011). Adhesive capsulitis: A Review. American Family Physician, 83(4), 417.

Yang, J.I., Jan, M.H., Chang, C.W., Lin, J.J. (2012). Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: A randomized control trial. Manual Therapy, 17(1), 47-52.