Thawing a frozen shoulder

Tim Barnwell, APA Sports Physiotherapist

What is a frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition that affects your shoulder joint and usually involves the gradual onset of severe and disabling shoulder pain, coinciding with a loss of range of motion of the shoulder [1].

The condition can last from 12-18 months, with some cases lasting up to four years.

In most cases, normal range of motion will return [2].

With frozen shoulder, the shoulder capsule becomes so thick and tight that it’s hard to move. The shoulder capsule is the tissue surrounding your shoulder joint that holds everything together.

The shoulder is made up of three bones: The clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).

The shoulder has a ball-and-socket joint. The round head of the upper arm bone fits into this socket. Connective tissue, known as the shoulder capsule, surrounds this joint. Synovial fluid enables the joint to move without friction.

Image source: American Academy of Orthopaedic Surgeons

Symptoms, causes and diagnosis

The main symptoms of a frozen shoulder are pain and stiffness, for no apparent reason, that make it difficult or impossible to move the shoulder.

The pain may feel worse at night or in cold weather.

Frozen shoulder is thought to happen when scar tissue forms in the shoulder, which causes the shoulder joint’s capsule to thicken and tighten, leaving less room for movement.

The exact cause cannot always be easily identified.

However, most people with frozen shoulder experience immobility as a result of a recent injury or fracture.

It’s not clear why some people develop it, but some groups are more at risk.

Females aged 40 to 65 are most likely to be at risk of developing a frozen shoulder, along with anyone who has had a frozen shoulder previously on the other shoulder.

It is also more common in those who are sedentary rather than active [3].

The condition is also common in people with diabetes and thyroid disease.

Frozen shoulder can usually be diagnosed with an examination by a GP or physiotherapist, usually along with an x-ray and ultrasound of the shoulder.

Three phase course of the condition

  1. Freezing – You develop a pain in your shoulder any time you move it, and your range of shoulder movement is reduced. It slowly gets worse over time and may hurt more at night. This can last anywhere from two to nine months.
  2. Frozen – The pain might be less but your shoulder stiffness gets worse and moving your shoulder becomes more difficult. This stage can last anywhere from four to 12 months.
  3. Thawing – Your range of motion starts to go back to normal. This can take anywhere from five months to two years.

Treatment options

Though the reasons for the development of frozen shoulder remain unclear, a range of treatment options are available that are suitable for each phase of the condition:

The benefit of exercise

Physiotherapy is widely recommended as treatment for frozen shoulder.

As the scapula can be disrupted due to a frozen shoulder, exercises to correct its movement can be useful.

Functional exercises have been shown to reduce the incidence of shoulder pain [6].

This involves physical treatment, with a long-term supervised exercise program incorporating strengthening and stretching exercises and reassurance about the activities you can undertake and continued exercise.

A recent study found that patients with a positive expectation of treatment had a better outcome [7].

If you are experiencing the early signs of frozen shoulder, book a consultation now with your local Lifecare physiotherapist to discuss the treatment options that are right for you.