Introduction
Frozen shoulder is an initially inflammatory condition where the shoulder joint appears to become restricted, making it hard to move through full ranges of movement. These limitations are often accompanied by pain at first.
The shoulder joint is supported by a strong lining called a joint capsule, which helps to keep the joint in place. Within the joint capsule, there is synovial fluid (gel-like substance) which lubricates the joint, allowing the shoulder to move smoothly.
With frozen shoulder, the capsule appears to thicken and tighten up, and the amount of synovial fluid in the joint decreases. These factors contribute to initial restriction of movement which may affect daily tasks / activities such as:
- Overhead motions (washing / combing hair)
- Reaching behind your body
- Lifting and reaching motions
Stages of Frozen Shoulder
The course of frozen shoulder generally follows three main stages, which are often overlapping, rather than following clearly distinguished time frames.
- “Freezing” (6 weeks-9 months):
- Persistent pain (can be severe at times) and stiffness
- Sleep is disturbed
- Limited shoulder movement in all directions, particularly external rotation
- “Frozen” (2-6 months):
- Pain is less intense except at extreme ranges of movement
- Shoulder stiffness remains
- “Thawing” (9-36 months):
- Condition begins to resolve
- Minimal or no pain
- Gradual return of shoulder movement (may or may not fully return)
Who Gets Frozen Shoulder?
Frozen shoulder appears to occur without specific or obvious reasons. However, it is observed that it is commonly associated with prolonged periods of reduced usage of the shoulder that may result during recovery from a surgery, fracture (collar bone, shoulder blade, upper arm) and rotator cuff injury where the shoulder may be in sling, brace
Other contributing factors are:
- Gender – affects women more than men
- Age – usually affects those over 50 years old
- Underlying health conditions (diabetes, thyroid disorder, parkinson’s disease, cardiac disease, stroke)
Conservative Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and inflammation
- Corticosteroid injection
- Hydrodilatation injection (stretches the shoulder joint capsule) as performed by a radiologist
- Physiotherapy has shown to bring about active pain relief and recovery, restoration of range of motion, strength and return to daily activities (Page et al. 2010).
Physiotherapy and Rehabilitation
The physiotherapeutic approach is tailored according to the stage of the condition.
- Freezing
Low-grade (gentle) shoulder mobilisations within a tolerance, pain relief with modalities, gentle range of motion exercises.
- Frozen
High-grade shoulder mobilisations, pain relief with modalities, range of motion and gentle strengthening exercises.
- Thawing
High-grade shoulder mobilisations, intermediate to advanced strengthening exercises.
Surgical Intervention
If frozen shoulder does not respond to conservative treatment, arthroscopy surgery to release or stretch the scar tissue is an option. Following the surgery, a rigorous physiotherapeutic rehabilitation protocol to restore the range of motion and function will have to be followed.
Takeaway
Full recovery of a frozen shoulder takes time, regardless of conservative or surgical management. Patience, endurance and resilience are of utmost importance during this recovery period.
