Frozen Shoulder, also known as, Adhesive Capsulitis

Adhesive capsulitis, more commonly known as frozen shoulder, is somewhat of an enigma in the medical world, as it has no known underlying cause. It is a condition that occurs only in the shoulder and usually has an insidious onset, that is, there is no mechanism of injury or direct causal link, but symptoms come on seemingly randomly and build of their own accord.

We still don’t know exactly why frozen shoulder occurs, but we have been able to identify several risk factors that include;

  • Diabetes
  • Thyroid disorders
  • Atherosclerotic diseases
  • Cervical disc diseases
  • Women between the ages of 40-60 years

We can also divide types of frozen shoulder into three main categories;

  1. Primary idiopathic – which develops without rhyme or reason
  2. Post-traumatic – following some form of trauma such as a fracture to the humerus
  3. Post-surgical – follows surgery to the shoulder such as a rotator cuff repair

Most people that suffer frozen shoulder describe a pain in their shoulder that slowly increases in intensity, becoming constant, and limits their function. Pain will be present at rest and usually has a severe impact on their ability to sleep. The pain can start to radiate down the arm as far as the hand. This phase is commonly known as inflammatory or reactive stage, where pain is the primary symptom.

Once pain has reached its peak, people start to notice that their shoulder is stiffening up, and they lose their ability to lift their arm, open their arms wide, or rotate their arm outwards. Slowly the shoulder becomes more and more stiff. This phase is known as the frozen stage, where pain and stiffness are both present. Eventually the shoulder freezes, and range of motion become static. They key finding of frozen shoulder is that the passive range of motion (that is, how far the arm moves when you are completely relaxed and someone else moves it for you) is equal to the active range of motion (that is, how far you can move your arm yourself using your muscle strength). The frozen stage can last for months to even years, and there is no way of knowing how long this stage will last.

Eventually, the shoulder then enters the thawing out stage, where the shoulder begins to regain some of its flexibility and function. Physiotherapy treatment is most effective in the thawing out stage where a range of modalities may be used to ease pain and regain range of motion. Physiotherapy in the early stages, however, may provide some short-term symptomatic relief, but often does not have any maintained benefit. Once a person has reached the frozen stage, they will usually consult a physiotherapist periodically to monitor their progress and ensure they are continuing the appropriate stretches to maintain the range of motion and function that they have.

Frozen shoulder is best confirmed using an MRI to identify adhesions of the shoulder joint capsule. The length of an episode of frozen shoulder can range anywhere from months to years, with the average being approximately 18 months1. Physiotherapy treatment is essential to regain your range of movement and improve your strength

If you feel your shoulder pain symptoms are very familiar to what has been described, it is essential to see your GP or call Sydney West Sports Medicine on (02) 9851 5959 and book an assessment with our Physiotherapists.

1 Vastamäki, H., Kettunen, J., & Vastamäki, M. (2012). The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study. Clinical orthopaedics and related research, 470(4), 1133–1143. doi:10.1007/s11999-011-2176-4

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