Diagnosis and treatment for this condition....how your physiotherapist or sports therapist can assist you.....
What is ‘frozen shoulder’ and what causes the condition?
Frozen shoulder’ is medically known as ‘Adhesive Capsuilitis’. It is a condition which involves the connective tissue surrounding the shoulder, the capsule. The shoulder capsule is an envelope of tissue that surrounds the shoulder joint which can become inflamed and result in tightening and scarring of the shoulder joint capsule. It is thought that some scar tissue forms in the shoulder capsule.
The scar tissue may cause the capsule to thicken, contract and limit the movement of the shoulder. The reason why the scar tissue forms is not known. The shoulder becomes painful and stiff and shoulder movements become reduced; sometimes completely 'frozen' hence the umbrella term ‘frozen shoulder’. Without treatment, symptoms usually go, but this may take up to 2-3 years. Various treatments may ease pain and improve the movement of the shoulder.
A frozen shoulder occasionally follows a shoulder injury. However, this is not usual and in most cases can occur for no apparent reason.
What are the symptoms of ‘frozen shoulder’?
The typical symptoms are pain, stiffness, and limitation in the range of movement of the shoulder. The symptoms typically have three phases:
Phase one - the 'freezing', painful phase. This is the painful stage when you will usually present to a healthcare practitioner for accurate diagnosis. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night and when you lie on the affected side.
Phase two - the 'frozen', stiff (or adhesive) phase. This typically lasts 4-12 months. Pain slowly eases but stiffness and limitation in movement remain and can become more significant. All movements of the shoulder are affected. However, the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste too as they are not used.
Phase three - the 'thawing', recovery phase. In this stage the shoulder slowly starts to recover and the shoulder becomes looser and movement gradually returns . This typically lasts between one and three years.
Symptoms often interfere with everyday tasks and work life may be affected in some cases.
The symptoms occur gradually over time. As highlighted earlier, an initial sign is stiffness in the shoulder; however many other shoulder conditions also present with a stiff shoulder and therefore that cannot be used to rule in or out a diagnoses of ‘frozen shoulder’.
A strong dull ache within the shoulder joint is common, with pain usually increased with movement of the joint. Patients will present with difficulty in tasks such as putting on a jacket, tying up a bra and washing their hair or any other overhead movements at first. As the condition worsens the level of restriction will increase and normal day to day activities can become increasingly difficult and painful.
Who gets ‘Frozen Shoulder’?
Frozen shoulder affects about 3% of adults at some stage in their life. It most commonly occurs in people aged between 40 and 65 years. It is more common in women. It is more common than average in people who have diabetes. If you have diabetes, your risk of developing a frozen shoulder is increased. The exact reason for this is unknown. It is estimated that people with diabetes are twice as likely to develop a frozen shoulder compared with those who do not have diabetes. If you have diabetes, your frozen shoulder symptoms are likely to be more severe. You are also more likely to develop the condition in both shoulders.
Your risk of developing a frozen shoulder may also be increased if you have other health conditions including:
Dupuytren's contracture - where small lumps of thickened tissue form in the hand, causing the fingers to bend into the palm of the hand
- heart disease
- lung disease
- thyroid disease
- breast cancer
Despite these links a direct cause for ‘frozen shoulder’ is still unknown.
Either shoulder can be affected but most commonly it is the non-dominant shoulder. In about 1 in 5 cases the condition also develops in the other shoulder at some stage. It is very uncommon to have frozen shoulder more than once in the same shoulder.
Note: frozen shoulder is not a form of arthritis and other joints are not affected.
An accurate diagnosis of ‘frozen shoulder’ can be made by your physiotherapist or sports therapist with a comprehensive subjective history and thorough examination. Your therapist may also decide to confirm the diagnosis and refer you for an MRI or a diagnostic ultrasound.
Treating the Condition
The management of ‘frozen shoulder’ can be greatly assisted by your therapist by using various techniques to help manage pain and restriction, help decrease the effect on your daily life and monitor any progression into different stages of the condition. It is important to note however, that therapy cannot ‘cure’ the condition and treatment is widely focused on maintaining as much shoulder movement as possible, managing the pain and when in the thawing stage, ensuring a speedy recovery and return to normal shoulder movements.
All treatments used at Revolution Sports Injuries Clinic are based on the latest body of evidence to support the use of the modality in treating ‘frozen shoulder’ and / or in conjunction with other modalities to provide the best possible outcome for the individual.
The use of corticosteroid injections have been shown to help reduce the effects of the inflammatory stage allowing your therapist to work with you sooner. However their effect appears to be best used during the initial inflammatory stage with little or no effect after this.
In severe cases surgery can also be indicated, an athroscopic capsule release has been shown to have a good effect at restoring motion and relieving pain, where the tight capsule is released surgically.
The nature of this condition is different to others where you generally have to wait until the condition wears itself before it resolves. This does not mean you can do nothing to help it though; there are lots of exercises and management techniques that your therapist can assist with to ensure this restrictive condition does not have too large an impact on your life.