Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulder (FS), aka adhesive capsulitis, is a condition where your shoulder joint becomes very painful and begins to lose movement in at least two directions. FS is more prevelant in women aged 40-65, and in the diabetic population. What causes the freezing or stiffening is still up for debate with more research leaning towards the idea that inflammation triggers the capsule surrounding the shoulder to become fibrotic or stiff.

What Causes Frozen Shoulder?

Frozen shoulder can occur after an injury, surgery, or some other type of trauma such as disease, diabetes, or fractures. FS can also be idiopathic and occur quite randomly. Typically in our practice we see it occur after injury and this is why it is extremely important that you get assessed after any trauma big or small, to the shoulder, arm, and neck region.

The Phases:

1. Freezing (3-9 months): gradual onset of pain even at rest and at night, extreme pain with movement. Shoulder range of motion begins to decrease.

2. Frozen (4-12 months): Pain is less at rest, only apparent with movement of the shoulder. The range of motion is very limited.

3. Thawing (1-3 years): Pain is minimal and range of motion progressively returns to normal.

 

Management and Prevention

The best way to prevent FS from occurring is to seek treatment immediately after injury or surgery to control inflammation and maintain range of motion. 

Recent studies have concluded that in true cases of FS that have already begun the Freezing phase, corticosteroid injections are beneficial to stop inflammation and help with pain so the patient can continue to move and function. After a 4-6 week period since onset, Physiotherapy intervention has been shown to be more beneficial than corticosteroid injections. The earlier the intervention, the better the outcome!

Shockwave therapy, joint mobilizations, and acupuncture are also techniques we use and has produced effective results.

Conclusion

Frozen shoulder can be very painful and very limiting. Seeking advice early after an injury is the best way to prevent FS and to recover faster. When pain is a severe factor, injections are recommended followed by physiotherapy intervention to assist with range of motion exercises. Being aware that this condition can take months to years to fully recover is important for patient goals, however we have seen with timely and proper treatment patients can recover to 85-95% range of motion and 100% pain free within a few months.

 

Don't take the 'wait and see' approach to shoulder pain, get assessed and get treated to avoid suffering for 1-3 years!