Frozen shoulder (or adhesive capsulitis) is a painful condition in which the tissue of the shoulder capsule thickens and tightens up, causing pain and reduced range of movement in the joint.
What causes frozen shoulder?
It's unclear as to exactly why frozen shoulder occurs, though there seems to be a few risk factors:
Prolonged immobility has a strong correlation with the onset of adhesive capsulitis, typically following injuries such as rotator cuff tears, shoulder dislocation and surgery.
Certain medical conditions can also predispose the issue. These include diabetes, overactive thyroid, underactive thyroid, cardiovascular disease and Parkinson's disease.
It is also more common in people, particularly women, over the age of 40.
Stages of frozen shoulder
There are typically 3 main stages of adhesive capsulitis:
Freezing stage - this is the first stage, where the shoulder becomes painful on movement and the range of movement begins to diminish.
Frozen stage - this is the middle stage, where the shoulder is at its most limited, although pain may start to reduce.
Thawing stage - this is the final stage, where the range of movement in the shoulder starts to improve.
How will I know if I have frozen shoulder?
Your GP or therapist will be able to perform a number of tests to help determine the cause of your pain.
Adhesive capsulitis affects all movements of the shoulder, both active (using muscles) and passive (where the muscles stay relaxed). Some other shoulder conditions may affect a few movements but not all of them.
Sometimes you may be referred for scans, most commonly x-rays or ultrasound to help rule out other issues.
It's quite common for frozen shoulder to be confused with other painful conditions of the shoulder, including rotator cuff injuries, biceps tendinitis, subacromial bursitis and acromioclavicular arthropathy.
How is frozen shoulder treated?
Unfortunately, adhesive capsulitis typically takes a long time to recover - usually between 1.5 and 3 years. Generally treatment involves pain management, whether that is avoiding painful actions or having your GP prescribe pain relieving medications.
Mobility exercises can also be prescribed by your therapist These will help both maintain and improve range of motion in the affected shoulder. Your commitment to these exercises will help to determine your recovery rate - early "use it or lose it" intervention can be quite beneficial.
Your practitioner may even use manual therapy techniques such as massage, trigger point stimulation, articulation and acupuncture to help you with your recovery.
It is important to remember that strength of the muscles is not the issue with adhesive capsulitis, so working the muscles at the gym will not be a great help. Over-exertion can often make symptoms worse, so it is worth taking a step back from strenuous exercise while you recover.
In persistent cases of frozen shoulder there are also some surgical options, including steroid injections for pain relief or manipulation under anaesthetic for increasing movement.