Frozen Shoulder (Adhesive Capsulitis)
The Cause, Symptoms and How Physiotherapy Can Help.
What Is Frozen Shoulder?
Frozen shoulder is a condition when a shoulder becomes painful and stiff. It may happen following an injury, overuse, or from a disease such as diabetes or a stroke. The shoulder is a spheroidal joint (ball – and – socket joint), in which the round part of one bone fits into the concavity of another. The proximal humerus (round head of the upper arm bone) fits into socket of the scapula (shoulder blade). Frozen shoulder is thought to be due to scar-like tissue forming in the shoulder capsule (a sac of ligaments surrounding the joint), which thickens and becomes tight. In many cases, there is less synovial fluid (lubrication) in the joint. As a result, the shoulder joint stiffens and shoulder movements become reduced, often times causing pain and sometimes becomes completely ‘frozen’.
This condition usually comes on slowly. Without treatment, symptoms can resolve on their own, though may take up to 2-3 years. Frozen shoulder occurs in about 3% of the general population. It most commonly affects people between the ages of 40 and 65, and occurs in women more often than men. It typically affects only one shoulder, most commonly in the non-dominant shoulder, however one in five cases affect both.
The term “frozen shoulder” is often used synonymously for arthritis, though this is incorrect as the two conditions are unrelated. Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other/multiple joints.
Frozen shoulder is thought to be caused by the formation of scar tissue in the shoulder, which makes the shoulder joint’s capsule (not to be confused with the rotator cuff) thicken and tighten, leaving less room for movement. Therefore, movement may be stiff and even painful.
Causes of Frozen Shoulder
The cause of frozen shoulder is not clear. Frozen shoulder can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or a stroke. Any shoulder problem can lead to frozen shoulder if you do not work to keep full range of motion (think: If you don’t use you, you lose it!).
It is thought that some scar tissue forms in the shoulder capsule. The capsule is a thin tissue that covers and protects the shoulder joint. The scar tissue may cause the capsule to thicken, contract and limit the movement of the shoulder. The reason why the scar tissue forms is not known.
A few factors may put you more at risk for developing frozen shoulder:
- After surgery, fracture or other injury
- Age: most often in people between 40 and 65 years old
- Gender: women are more likely to suffer from frozen shoulder than men, especially postmenopausal women.
- Most often in people with chronic diseases: diabetes, thyroid disease, Parkinson’s disease, stroke or cardiac disease.
Stages Of Frozen Shoulder
The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else. It develops in three stages:
- Stage one – Freezing: in the “freezing” stage, you slowly have more and more pain, usually without a precipitating factor. As the pain worsens, your shoulder gradually loses range of motion. Freezing typically lasts from 6 weeks to 9 months. The pain is typically worse at night and when you lie on the affected side.
- Stage two – Frozen: painful symptoms may actually improve during this stage, but the stiffness remains and the limitation in movement can get worse. All movements of the shoulder are affected. During the 4 to 12 months of the “frozen” stage, daily activities may be very difficult.
- Stage three – Thawing: shoulder motion slowly improves during the “thawing” stage. The pain and stiffness gradually go away and movement gradually returns to normal, or near normal. Complete return to normal or close to normal strength and motion typically takes from 12 months to 2 years. Although approximately 40% of patients have slight, persistent limitations in range of motion, only 10% have clinically significant long-term functional limitations.
Signs and Symptoms of Frozen Shoulder
- Pain, usually dull or aching and typically worse early in the course of the disease
- Stiffness, may be worsened by repetitive movements of the involved upper extremity
- Progressive loss of range of motion
- Difficulty performing daily activities such as grooming one’s hair, reaching for a seatbelt overhead, reaching for a back pocket or bra strap
Physiotherapy Treatment for Frozen Shoulder
Step 1 – Thorough History & Assessment
The key to an effective treatment plan is to have the correct diagnosis. We start every management plan with a thorough history of your condition followed by a physical exam to ensure the correct diagnosis is made and to rule out any medical condition for which further evaluation may be required. We then discuss our findings and treatment options and together come up with a treatment plan. Once this is agreed upon, treatment typically starts on the first visit. On occasion, a referral to your doctor will be necessary for further testing (ex. blood work or x-rays) prior to treatment.
Step 2 – Pain Management
Managing pain is usually a primary goal for patients with frozen shoulder. Your physiotherapist will choose from a variety of modalities the most appropriate for your particular case. These modalities may include electrotherapy (interferential current, TENS), heat therapy, and manual techniques to help improve your pain.
Step 3 – Restoring Range of Motion and Strength
Increasing range of motion is the most important part of the rehabilitation process. Manual therapy techniques (passive range of motion, joint mobilization, muscle energy technique, and facilitation techniques) in addition to an exercise routine, including stretching and range of motion exercises will help you to restore shoulder flexibility and range of motion. Once you range of motion is restored, an individualized strengthening exercise program, targeting specific muscles will help to increase your strength, and overall function.
Step 4 – Restoring Function
Most patients with frozen shoulder experience difficulty with certain activities, such as grooming one’s hair, reaching overhead, and reaching back. Restoring function is the ultimate goal of the physiotherapy treatment. As part of your rehabilitation process, a functional exercise program is designed to help you improve your function and facilitate your daily activities.
If your symptoms are severe and conservative treatments have not worked after six months, your physiotherapist may recommend following up with your doctor to discuss other treatment options. Some of the procedures used to treat frozen shoulder include a steroid injection and surgery. It is important to talk with your doctor about your prognosis with various treatment interventions such as Physiotherapy, and the risks involved with surgery. It is uncommon to need surgery for a frozen shoulder, but it may be recommended.
Step 5 – Education
Understanding your condition is the first step in your recovery. Educating you about your condition, what to expect and giving you the tools to self-manage is a fundamental part of the rehabilitation process. Good communication with your physiotherapist is key to have positive outcomes.
Would you like to get help resolving your frozen shoulder faster, without surgery?
Make An Appointment OnlineOur online scheduling system will let you choose the type of appointment you need, which provider you want to make an appointment with, and when appointments are available. Please note that after making an appointment, you will receive a confirmation email as soon as you make the appointment and an appointment reminder the day before your appointment delivered directly to your email.
Call Us To Make An AppointmentTo schedule an appointment by phone, please call our office at 902-407-7207, anytime. When you call, we will be happy to answer any questions regarding the conditions we treat, clinic fees and billing practices, or any other questions you may have.
Question Before Booking?
Let us know your questions or concerns and we will be happy to respond quickly. If you’d like one of our provider’s to contact you, please provide your contact information.
“My first meeting with Dr. Nick helped to put the pain in context. Finally, an explanation and some real answers.”
– Jeff Smith, Sackville, NS