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Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder also known clinically as adhesive capsulitis is a condition that leads to pain and stiffness in one or both shoulders. Typically shoulder pain begins with a gradual onset that can become more severe over a number of months. Pain is usually followed by increased stiffness making it difficult to carry out day to day activities. In the most severe cases of adhesive capsulitis you may not be able to move the shoulder at all.


What causes a Frozen Shoulder?


Frozen shoulder occurs when the surrounding ligaments of the shoulder joint known as the glenohumeral joint capsule become inflamed and thickened. It is not fully understood why this happens but the risk of developing a frozen shoulder can increase with;

  • A previous shoulder injury

  • Shoulder surgery

  • Diabetes

  • Thyroid Conditions


Signs and Symptoms of Frozen Shoulder


Pain, followed by a gradual onset of stiffness are the main complaints of frozen shoulder. Full range of motion and normal shoulder movements become increasingly difficult and painful. Progression usually leads to difficulty in normal day to day activities including driving, cleaning and bathing to name a few. Sleeping comfortably can also become an issue. You may also notice a loss in muscle mass and strength due to a lack of use.


Stages of Frozen Shoulder


There are 4 stages to Frozen shoulder that can range from 4 months to 2 years.


  • Stage 1 - Pre-adhesive Stage; Full or slightly limited range of motion with slight/gradual pain at the shoulder

  • Stage 2 - Acute adhesive synovitis (Freezing stage); early adhesions in the glenohumeral joint capsule and slight limitation in range of motion, pain becomes more constant and may radiate. Beginnings of the shoulder ‘seizing up’ making it difficult to perform daily activities (2-9 months)

  • Stage 3 - Maturation Stage (Frozen stage); Shoulder has become increasingly stiff, no pain at rest, however, pain is more likely with attempted motion especially at the end range of motion. Muscle atrophy may be noticed (4-12 months)

  • Stage 4 - Chronic Stage (Thawing stage); Gradually improved range of motion, can still be painful but likely that pain will slowly fade (12 months+)


Diagnosing Frozen Shoulder


Frozen shoulder can be difficult to diagnose as it rarely shows on imaging, but by taking a case history and performing an assessment of the shoulder we can help differentiate it from other shoulder conditions through a process of elimination.


Treatment


Treatment often depends on the severity of the symptoms. Although most cases can resolve independently of treatment, that can often take months or even years to resolve. Treatment aids to minimise pain and discomfort as well as speed up recovery time. Conservative treatment usually consists of


  • Soft tissue techniques to surrounding shoulder musculature

  • Manipulation/mobilisations to the neck, back and shoulder

  • Stretching and traction techniques

  • Home exercise to stretch and strengthen

  • It may also help to use heat and ice packs


If symptoms fail to improve we may refer you for a steroid injection which can aid recovery in some cases.


Working with Frozen Shoulder


Frozen shoulder can sometimes mean taking a little time off work to help recovery. How long though will depend on a few things like the role at work and how bad the condition is. It is not necessary to be completely symptom free before returning to work though as gradually returning back to normal activities can help build up strength and stamina.


Overall Prognosis


Frozen shoulder is very amenable to conservative treatment however it can be a difficult and  frustrating condition to manage. Treatment for the condition may take a year or more to resolve. 60% resolve without treatment after 2 years with limiting results compared to those with treatment. Most patients return to a 90-100% shoulder function following frozen shoulder treatment.

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