Frozen Shoulder – What Is It and How Do I Treat It?

Frozen shoulder, also known as "adhesive capsulitis", is a debilitating condition that affects approximately 5% of the population, and is characterized by pain, stiffness and limited range of motion and function of the shoulder¹. Clinically, it has been defined as an inflammatory contracture of the shoulder joint capsule². Contracture of the shoulder ligaments, as well as muscular and fascial tightness, are also important contributors to the limitation in movement observed with a frozen shoulder¹. The shoulder movements that are predominantly limited with a frozen shoulder are flexion (lifting the arm up in front of you), abduction (lifting the arm up to the side) & external rotation (turning the arm outward). The scientific literature has demonstrated that women are more likely to develop a frozen shoulder. However, men are more likely to have a greater recovery and increased disability afterward³.

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Classifications¹

  • Idiopathic or primary adhesive capsulitis: occurs spontaneously, without a particular precipitating event. It results from chronic inflammation and excessive stimulation of fibroblastic proliferation. This is believed to be an abnormal reaction of the immune system.
  • Secondary adhesive capsulitis: occurs post shoulder injury or surgery. This form of frozen shoulder may be associated with other conditions such as rotator cuff injuries.

The 3 Stages of Frozen Shoulder¹

The scientific literature has identified 3 stages of frozen shoulder: the painful stage, the frozen or stiffness stage, and the "thawing" stage. The average length of symptom presence for a frozen shoulder has been estimated to be approximately 30 months, with the frozen or stiffness stage typically lasting the longest¹.

Consequences of A Frozen Shoulder

  • Muscular imbalances at the shoulder: patients with a frozen shoulder often present with altered shoulder movement secondary to muscle imbalances at the shoulder. More specifically, the upper trapezius muscle tends to be more active when lifting the arm when compared to the inferior trapezius muscle according to a study that measured the muscle activity of these two muscles during arm elevation⁴. This is likely caused by decreased capsular extensibility and alterations in motor control and firing patterns of these two muscles¹.
  • Poor posture: protraction of the shoulders (shoulders situated more forward with respect to the trunk) and increased thoracic kyphosis (increased curvature of the upper back) are commonly seen in patients with a frozen shoulder This, in turn, may further contribute to the muscular imbalances at the shoulder.

Frozen Shoulder Treatment

A frozen shoulder is typically treated conservatively with medication and physiotherapy. A 90% success rate has been demonstrated with conservative treatment over a four month period⁵.

  • Physiotherapists treat a frozen shoulder using a variety of techniques, including mobilizations of the shoulder joint, modalities to relieve pain, myofascial release/trigger point release to relax tight muscles, and exercise prescription to optimize the strength and flexibility at the shoulder. Want to know which shoulder exercises you should be doing for your frozen shoulder? Take a look at my previous post: "The 5 Exercises You Should Be Doing If You Have A Frozen Shoulder".
  • Other non-operative medical treatments include injections into the shoulder joint. These injections typically contain a corticosteroid to reduce inflammation, as well as an anesthestic to relieve pain. Corticosteroid injections have been shown to be more effective within the first 6 weeks of a frozen shoulder. In addition, saline may be included in the injection to help distend the joint and increase the joint space to allow for an increase in shoulder range of motion. This is referred to as an arthrodistension of the shoulder. Arthrodistensions (also known as distension arthrography) demonstrate better results when combined with physiotherapy so that range of motion can be optimized with the newly distended shoulder joint capsule¹.

How Do I Know If I Have A Frozen Shoulder?

The answer to this question is simple! Consult your physiotherapist for a thorough evaluation of the shoulder. They will confirm if you indeed have a frozen shoulder. Consult your doctor for the prescription of any medications that may help relieve your shoulder pain so that you can be more functional throughout your day.

Written by:
Anthony Teoli MScPT
Registered Physiotherapist

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If you have any questions or concerns regarding frozen shoulders and how to treat them, please consult your doctor or physiotherapist. If you have any questions or concerns regarding the content of this blog post, you may contact me directly infophysiotherapy10@gmail.com.

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. The content of this blog is a resource for information only. This blog was created to serve as an information resource for both the general population and health professionals. For any further questions or concerns regarding your frozen shoulder and how to treat them, please consult your doctor or physiotherapist.

References

1. Page, P. & Labb, A. (2010). Adhesive Capsulitis: Use the Evidence to Integrate Your Interventions. North American Journal of Sports Physical Therapy, 5(4), 266-273.

2. Tamai, k. Akutsu, M, & Yano, Y. (2014). Primary frozen shoulder: a brief review of pathology and imaging abnormalities. Journal of Orthopaedic Science, 19(1), 1-5.

3. Sheridan, M. A. & Hannafi, J. A. (2006). Upper extremity: emphasis on frozen shoulder. The Orthopedic Clinics of North America, 37(4), 531-539.

4. Lin, J. J., Wu, Y. T., Wang, S. F. & Chen, S. Y. (2005). Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clinical Rheumatolology, 24(6), 569-575.

5. Levine, W. N., Kashyap, C. P., Bak, S. F., Ahmad, C. S., Blaine, T. A., & Bigliani, L.  U. (2017). Nonoperative management of idiopathic adhesive capsulitis. Journal of Shoulder and Elbow Surgery, 16(5), 569-573.

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