Frozen shoulder is a painful and disabling condition that can persist for long periods of time. Within the current research literature frozen shoulder is still a subject of great debate, particularly as the reason for its onset is not greatly understood.

 

What is it?

Frozen shoulder is a condition that is characterised by significant pain and restriction in range of motion at the shoulder. Originally, frozen shoulder was suspected to be as a result of adhesions in the joint capsule – the ligaments that surround the shoulder, and that this tightness restricted the motion of the shoulder. However this may not be the case. There is likely a significant inflammatory component to its onset for most people, however studies have shown that frozen shoulder can occur in the absence of capsulitis and pain may be as a result of fear of movement and local muscle guarding/spasms.

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Frozen shoulder typically presents in people aged 40-60 years. The condition preferentially affects people with diabetes mellitus, thyroid problems, or smokers and may affect people with a history of shoulder trauma, such as fracture. Unfortunately though frozen shoulder usually has an onset without any preceding event.

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Signs and symptoms

Typically frozen shoulder is thought to present in three stages, a painful freezing stage, frozen stage, and thawing, however these stages may overlap and there is no set timeframe on how long each phase may last. It usually begins with:

• Significant night pain, impacting sleep

• Painful restriction in shoulder movement - dressing, reaching overhead or reaching behind are painful and limited.

As time goes on, the pain at night will ease, and people affected are usually left with a stiff shoulder, with limited movement. Frozen shoulder is thought to be self-limiting – in that it will resolve over time, however it can last for up to a few years.

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Diagnosis

A physiotherapist can diagnose a frozen shoulder, through a combination of subjective questions and a physical assessments. The cardinal sign in a physical assessment that leads to a diagnosis is a loss of external rotation of the shoulder (turning your arm out), both when you move your shoulder, and when the physiotherapist moves your shoulder for you. Imaging, such as ultrasound can be helpful in diagnosis particularly in ruling out other pathologies that may present similarly.

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Management

Management in an acute phase is targeted towards pain relief. Physiotherapy can assist in this stage, helping to manage pain with hands on treatments. Discussions with your GP regarding pain relieving medications are also important. There is research to suggest that corticosteroid injections can be useful particularly in the first 6 weeks of onset for pain management.  Aggressive exercise with an acutely painful shoulder can be counterproductive, however your physiotherapist can guide you with gentle exercise and strategies to keep your shoulder moving while the pain settles.  In the later stages of a frozen shoulder when stiffness is the main complaint, physiotherapy is very important. Research shows that a progressive exercise program significantly speeds up recovery time.

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If you have shoulder pain, or think you might have a frozen shoulder and are struggling to manage your symptoms, we can help! Make an appointment with one of our dedicated physiotherapist to have your shoulder assessed and treated by calling (07) 3211 8775 or click here to book online.

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