Frozen shoulder involves the inflammation of the shoulder capsule and fibrous structures around the area that help to hold the shoulder joint in place. The inflamed structures tighten up, causing significant limitations in shoulder range of motion and pain during movement.
There are may be no specific or identifiable causes of shoulder capsulitis, apart from trauma to the shoulder joint. It is often misdiagnosed and may be difficult to identify at first, due to the patient’s general and non-specific complaints of pain and stiffness during its first onset. Many other shoulder conditions can reproduce similar symptoms, such as rotator cuff tears/tendonitis, shoulder impingement, and calcific tendonitis.
Frozen shoulder is less common in the general population, with 3-5% experiencing frozen shoulder during their lifetime. It is a lot more common in diabetics, with up to 20% experiencing frozen shoulder during their lifetime. Past shoulder surgery or injuries that reduce shoulder activity and movement, increases the risk of capsulitis. It has the possibility to occur bilaterally, and a previous incidence of a unilateral (one sided) frozen shoulder increases the chance of recurrence in the other shoulder.
There are three stages to frozen shoulder. Slightly different symptoms will be experienced during each stage.
- Freezing: Initial complaints of pain, followed by gradual loss of range of motion. Known as the red phase, as the joint capsule turns red as it is inflammed – this can be seen during surgery
- Frozen: There may be a lot less pain, however, the range of motion at the joint is still extremely poor, and there is a lot of stiffness. This is known as the pink phase, due to the fact that the joint capsule appears pink.
- Thawing: Gradual return to normal range of motion. Muscles are weak and tight due to disuse of the shoulder. This is known as the white phase as the joint capsule appears to be white.
Other general symptoms include:
- Poor Range of Motion: Inability to reach above shoulder height, to the side or behind.
- Poor Muscular Strength: Inability to perform sports related, or resisted movements
- Inability to sleep on affected shoulder. Night pains are also common.
- Difficulty performing daily activities (eg: brushing hair, reaching to back pocket, getting dressed)
Treatment & Management
Recovery is expected within 1-2 years of onset. However, slight deficits in range of motion are common, occurring in around 40% of cases. If possible, surgery should be avoided, and is only recommended when there is no improvement after 3-4 months of physiotherapy.
There is significant evidence to support the use of physiotherapy to treat frozen shoulder, as it helps to shorten the severity and duration of the condition. The prescription of exercises for range of motion and stretching are a great supplement to physiotherapy. Exercises to strengthen the muscle groups around the shoulder can be prescribed if there are significant deficits in strength.
If you have any questions please give us a call on 02 8705 2075 to speak to one of our therapist.