What is Frozen Shoulder or Adhesive Capsulitis?

Do you have a painful shoulder? Struggling to move your shoulder in any direction? You may be suffering from Adhesive capsulitis or frozen shoulder.

What is adhesive capsulitis? What causes frozen shoulder? What are the signs/symptoms? What does treatment involve? How long until a frozen shoulder gets better?  This article will answer all your questions about adhesive capsulitis or frozen shoulder.

If you’re not in the mood for reading have a look at this short video with Dr Abbey Davidson (Osteopath):

What is Frozen Shoulder?

Dr Abbey Davidson (Osteopath) with shoulder model explaining adhesive capsulitis or frozen shoulder to a patient.

Adhesive Capsulitis or Frozen Shoulder is a condition involving pain, stiffness and loss of range of motion at the shoulder joint. Frozen shoulder is more common in women and is most prevalent among individuals of 40-60 years old.  

The shoulder joint is a ball and socket joint with the humerus (arm bone), scapula (shoulder blade) and clavicle (collar bone) all contributing an articulating surface. Surrounding the shoulder joint, like any other synovial joint, is a joint capsule. A joint capsule consists of connective tissue layers which ‘incapsulate’ or seal the synovial fluid within the joint space. In adhesive capsulitis the joint capsule gradually thickens and tightens ( which restricts normal motion of the joint. With this process adhesions or thick bands of connective tissue similar to scar tissue can form.

Frozen shoulder is a condition which occurs in three distinct stages. Stage one or the ‘Freezing’ period is where there is progressive increase in the pain and loss of range of motion at the affected shoulder. This period can last anywhere for a few week to 9 months.

Stage two or the ‘Frozen’ period is where pain levels decrease but the severe lack of range of motion remains. This can last for upwards of 6 months. Stage three or the ‘Thawing’ period is where there is a slow and progressive return of range of motion to the shoulder. Again this period can last upwards for 6 months.

Causes of Frozen Shoulder:

Scientists are currently unsure of what the exact cause or trigger of adhesive capsulitis or frozen shoulder is. It will often occur spontaneously with no  obvious trigger. Some theories exist which try and explain what causes frozen shoulder. These include:

  • Autoimmune
  • Post-surgical
  • Injury/Trauma
  • Long term immobility/lack of use

We do know that adhesive capsulitis is more common in the diabetic population but are unsure why that is.

Symptoms of Frozen Shoulder:

Common symptoms of frozen shoulder or adhesive capsulitis are:

  • Constant shoulder pain
  • Stiffness
  • Decrease shoulder range of motion
  • Pain worse at night (even disrupting sleep)
  • Pain worse with cold temperatures  
  • Shoulder muscle tightness/cramps/spasm

If you believe you may be suffering from adhesive capsulitis it is important to be assessed by your physiotherapist or osteopath as soon as possible. Early diagnosis and treatment can result in better recovery from a frozen shoulder.  

How is Frozen Shoulder diagnosed:

Dr Marcus Ng using an image to explain to a patient the three stages of Adhesive Capsulitis or Frozen Shoulder

Your physiotherapist or osteopath will ask you a series of questions relating to you shoulder pain and stiffness. They will then perform a series of range of motion and orthopaedic tests to establish if you are truly suffering from a frozen shoulder. They will also consider you overall health as in some populations (e.g. diabetics) the incidence of adhesive capsulitis is much higher.

In some cases your health professional may send you for further imaging such as MRI, X-Ray or Ultrasound. This will be able to help in diagnosing an adhesive capsulitis and rule out other possible causes of your symptoms.

Adhesive Capsulitis is often misdiagnosed. It is important that you do not self-diagnose yourself with adhesive capsulitis is you have shoulder pain and stiffness. The shoulder is a complex joint and a number of pathologies can cause these symptoms. Some statistics state up to 3% of the general population suffer from adhesive capsulitis.

What you can do right now for Frozen Shoulder?

Unfortunately, true adhesive capsulitis is not a condition which can be resolved quickly. It is important that you understand the disease process and follow the advice of your health professional. Some basic advice will involve keeping your pain and inflammation under control and performing range of motion exercises.

For pain and inflammation management discuss with your GP or pharmacists about your options. Anti-inflammatory and analgesic medication may be indicated in your case. You may also consider topical application of anti-inflammatory creams. Avoid activities which aggravate your shoulder pain as these will increase inflammation and cause further restriction to the joint. On days where muscle spasm is particularly obvious trial the application of a heat pack at 20 minute intervals to encourage relaxation.

Range of motion exercises, like those demonstrated in the video at the top of page should be performed. These will aim to avoid further loss of range of motion and increase your range incrementally. Traction exercises using a weight and range exercises using a broom stick (or something similar) are easy range of motion exercises to start with. High repetitions are key performing 20-30 in each direction multiple times a day (within pain limits). While preforming these exercises you should be aiming to feel a comfortable stretch and not extreme pain. You are aiming to stretch the joint capsule not aggravate the shoulder.

Physio and Osteo treatment for Frozen Shoulder:

Dr David About (Osteopath) treating the shoulder with manual therapy techniques for a frozen shoulder

After giving you a clear diagnosis and explanation of you condition hands on therapy can begin. Hands on techniques attempt to maintain and improve range of motion, manage you pain, address the biomechanics of surrounding regions and address muscular tightness or spasm. The aim of your physiotherapist or osteopath will be to progress you through the three stages of adhesive capsulitis as soon as possible. Your therapist may refer you for corticosteroid injections throughout you treatment plan to complement what is happening in your sessions together.

As a result of having impaired range of motion in one shoulder other parts of the body can begin to present with symptoms due to over-working and compensating for the lack of shoulder motion. Your osteopath or physiotherapist is aware that this is a common side effect and will manage these prior to or as they occur.

Your physio or osteo will also prescribe “homework”. This will be exercises, stretches and lifestyle changes for you to perform on a regular basis. This will aim to improve you symptoms and range of motion even while you are away from the clinic. Compliance to this homework plays an important role in recovery and can speed up return to normal function.  

How long until Frozen Shoulder gets better?

Most cases of adhesive capsulitis resolve after time without surgery. Generally with a frozen shoulder you can expect 18 months to 3 years for full recovery. In some cases with strict adherence to you physio or osteo’s advice and treatment plan and at-home advice you will see results a lot faster than this.

Early diagnosis and treatment of a frozen shoulder is key to making the recovery process as speedy as possible. Please note that it is estimated that 20-30% of people who suffer from adhesive capsulitis will suffer the same condition in the other shoulder.

Rarely, in cases where there is significant period of time where the individual does not experience improvements (pain and range of motion) to conservative management, surgery may be considered.

By Sydney CBD Osteopath Dr Abbey Davidson

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