Man In Pain With A Frozen Shoulder

What is Frozen Shoulder?

Adhesive capsulitis, commonly known as frozen shoulder is a condition that causes severe stiffness, pain and loss of movement. It is usually spontaneous in nature, which progressively worsens, leading to disability that affects activities of daily living, work and leisure.

Frozen shoulder involves the growth and proliferation of blood vessels (angiogenesis) into the shoulder joint capsule, resulting in inflammation, increased collagen production and consequently contraction of the shoulder capsule and ligaments.

Frozen shoulder occurs in 4 stages and can last for 2-5 years.

Stage 1: Florid/ inflammatory: 0-3 months

  • Onset of pain along the outer shoulder muscles
  • Progressive loss of movement

Stage 2: Freezing: 3 – 9 months

  • Increasing stiffness and loss of movement

Stage 3: Frozen: 9- 15 months

  • Pain gradually subsides and only occurs at the end of movement
  • Stiff and limited movement, especially into rotation

Stage 4: Thawing : 15 – 24 months

  • Gradual improvement in movement

How is it diagnosed/ Who is it commonly seen in

A physio will determine whether or not you have frozen based on a thorough history taking and physical examination. Some things that we look out for are:

  • Night pain
  • Loss of shoulder movement, especially into rotation with your arms by your side (external rotation)

Risk factors that are attributed to the development of frozen shoulder:

  • Diabetes mellitus
  • Thyroid dysfunction
  • 40-65 years of age
  • Female > Male
  • Previous episode of frozen shoulder
  • Prolonged immobilisation (e.g. being in a sling post surgically)

Potential short and long term treatments

Frozen shoulder is a progressive, self-limiting condition, and can take a long time to fully resolve.

The key to managing frozen shoulder in order to maintain your function and movement is to getting it diagnosed and treated early.

Corticosteroid injections (CT/US guided into the joint capsule) combined with physiotherapy may potentially halt the progression of frozen shoulder.

Research has shown that joint mobilisations performed by a therapist combined with exercise to improve short-term outcomes.

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