Frozen shoulder or adhesive capsulitis is a common source of shoulder pain.
While frozen shoulder is commonly missed or confused with a rotator cuff injury, it has a distinct pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness. The more precise medical term for a frozen shoulder is “adhesive capsulitis”.
In basic terms, it means that your shoulder pain and stiffness is a result of shoulder capsule inflammation (capsulitis) and fibrotic adhesions that limit your shoulder movement.
What is Known about Frozen Shoulder?
Frozen shoulder causes your shoulder joint capsule to shrink, which leads to pain and reduced range of shoulder movement. Your shoulder capsule is the deepest layer of soft tissue around your shoulder joint, and plays a major role in keeping your humerus within the shoulder socket.
What are Frozen Shoulder Symptoms?
Frozen shoulder has three stages, each of which has different symptoms.
The 3 Stages are:
- Freezing – characterised by pain around the shoulder initially, followed by a progressive loss of range of movement. Known as the RED phase due to the capsule colour if you undergo arthroscopic surgery.
- Frozen – minimal pain, with no further loss or regain of range. Known as the PINK phase due to the capsule colour if you undergo arthroscopic surgery.
- Thawing – gradual return of range of movement, some weakness due to disuse of the shoulder. Known as the WHITE phase due to the capsule colour if you undergo arthroscopic surgery.
Each stage can last on average 6 to 8 months if left untreated.
How is Frozen Shoulder Diagnosed?
Frozen shoulder can be diagnosed in the clinic from your clinical signs and symptoms.
A clinical diagnosis of frozen shoulder can be determined by a thorough shoulder examination. Your practitioner will ask about what physical activities you are having difficulty performing.
Common issues include:
- Unable to reach above shoulder height
- Unable to throw a ball
- Unable to quickly reach for something
- Unable to reach behind your back eg bra or tuck shirt
- Unable to reach out to your side and behind. eg reach for seat belt
- Unable to sleep on your side.
Frozen Shoulder Treatment
Physiotherapy treatment for frozen shoulder depends on what stage you are in, and is tailored to your specific needs.
Pain relieving techniques including gentle shoulder mobilisation, muscle releases, dry needling and kinesiology taping for pain-relief can assist during this painful inflammation phase. Intracapsular corticosteroid injection by a GP is considered if pain is unbearable. It is important not to aggravate a frozen shoulder during this phase.
Shoulder joint mobilisation and stretches, muscle release techniques, dry needling and exercises to regain range and strength are useful for a prompt return to function. Care must be taken not to introduce any exercises that are too aggressive. Overenthusiastic treatment can aggravate your capsular synovitis and subsequently pain. A quality shoulder physiotherapist will know how much is enough and how much is too much.
Shoulder mobilisation and stretches are your best chance of a prompt return to full shoulder movement. As your range of motion increases your practitioner will be able to provide you with strengthening exercises to control and maintain your newly found range of movement.