Frozen shoulder, medically known as adhesive capsulitis, is a condition that causes pain, stiffness, and limited range of motion in the shoulder joint. It generally develops gradually, significantly impacting daily activities and quality of life. In this article, we’ll explore what frozen shoulder is, how it occurs, its phases, associated conditions, and the best approaches to managing it.

What Is Frozen Shoulder?

Frozen shoulder is a condition that affects the capsule of the shoulder joint —a connective tissue that surrounds the shoulder. In frozen shoulder, this capsule thickens and tightens, leading to reduced movement and discomfort.

The exact cause of frozen shoulder isn’t fully understood, but it’s often associated with inflammation, fibrosis, and adhesions forming in the joint capsule. This leads to restricted movement and the characteristic symptoms of pain and stiffness.

Key Symptoms:

• Persistent pain in the shoulder, often worsening at night.
• A gradual loss of movement in the shoulder joint. 
• Difficulty performing everyday activities such as dressing, reaching overhead, or putting on a seatbelt in the car.

What Causes Frozen Shoulder?

While the exact cause remains unclear, frozen shoulder is thought to result from a combination of factors, including:

1. Injury or Surgery: Immobilization of the shoulder following surgery, injury, or fracture can increase the risk of frozen shoulder.
2. Inflammation: Chronic inflammation in the shoulder joint, such as rotator cuff tendinopathy, may contribute to its development.
3. Systemic Conditions: People with certain medical conditions are at a higher risk of developing frozen shoulder, including:
   • Diabetes (affects up to 20% of patients with frozen shoulder).
   • Thyroid Disorders (both hyperthyroidism and hypothyroidism).
   • Parkinson’s Disease.
   • Cardiovascular Disease.

The Three Phases of Frozen Shoulder

Frozen shoulder typically progresses in three distinct phases, lasting anywhere from months to years:

1. Freezing Phase (Painful Phase)

• Duration: 6 weeks to 9 months.
• Characteristics:
  • Gradual onset of pain, which worsens over time.
  • Pain intensifies with movement and may disrupt sleep.
  • Increasing stiffness as the shoulder capsule begins to thicken and tighten.

2. Frozen Phase (Stiff Phase)

• Duration: 4 to 12 months.
• Characteristics:
  • Pain may reduce, but stiffness becomes more pronounced.
  • Significant loss of range of motion, making simple tasks difficult.

3. Thawing Phase (Recovery Phase)

• Duration: 6 months to 2 years.
• Characteristics:
  • Gradual improvement in shoulder movement and reduced stiffness.
  • Return to near-normal or full function in many cases.

Conditions Associated with Frozen Shoulder

Frozen shoulder often occurs alongside or after certain conditions, such as:

• Diabetes Mellitus: People with diabetes are 2-4 times more likely to develop frozen shoulder.
• Shoulder Injuries: Rotator cuff injuries or fractures may precede frozen shoulder.
• Post-Surgical Cases: Immobilization following surgery can trigger adhesive capsulitis.

Other Autoimmune and Endocrine Disorders: These may contribute to inflammation or fibrosis.

How Is Frozen Shoulder Diagnosed?

Diagnosing frozen shoulder involves a combination of:

• Medical History: Understanding the onset of symptoms and any contributing factors. Your physiotherapist will ask you a range of questions, your physiotherapist will then be able to determine whether your symptoms are presenting similarly to frozen shoulder. At this point you will move to the physical examination portion of your assessment. 
• Physical Examination: Assessing range of motion and pinpointing pain locations. When your physio assesses the range of motion in your shoulder you likely won’t be able to move it as much as previously. One way that frozen shoulder presents differently to regular shoulder injuries is that you won’t be able to move your shoulder completely, and your physio will also not be able to move your shoulder through range either as the stiffness in the joint is too much. 
• Imaging Studies: X-rays or MRIs may rule out other conditions such as arthritis or rotator cuff tears.

Treatment Options for Frozen Shoulder

Frozen shoulder treatment typically focuses on pain relief, maintaining/restoring range of motion, and maintaining/restoring strength of the shoulder. Common approaches include:

1. Physiotherapy

• Stretching Exercises: Gentle stretches help improve shoulder mobility over time.
• Strengthening Exercises: Targeted exercises reduce muscle imbalances and promote recovery.
• In the freezing phase of frozen shoulder, the main aim of physiotherapy is to maintain as much range and strength as possible. In this phase, you want to make sure you are not pushing into much pain. Pushing the joint will only make your shoulder really sore and won’t speed up the healing process. During the frozen and thawing phases we can start to push range and strength further as we will start to see quicker recovery this way. 

2. Pain Management

• Medications: Over-the-counter pain relievers (e.g., ibuprofen) can ease discomfort.
• Steroid Injections: Corticosteroids may be used to reduce inflammation and pain.

3. Other Interventions

• Hydrodilatation: A saline injection into the joint to stretch the capsule.
• Surgery: Rarely required, but arthroscopic capsular release may be an option in severe cases.

4. Lifestyle Modifications

• Maintaining gentle daily movements within a pain-free range.
• Avoiding prolonged inactivity, which can exacerbate stiffness.

Prognosis: How Long Does It Take to Recover?

Frozen shoulder usually resolves within 1-3 years, though recovery times vary (it can take up to 5 years). Early intervention through physiotherapy can significantly improve outcomes and reduce recovery time.

Final Thoughts

Frozen shoulder is a frustrating and often painful condition, but it’s also highly treatable with the right approach. If you’re struggling with shoulder pain and stiffness, seeking help from a physiotherapist can make all the difference.

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At EmbdyHealth we are experts when it comes to gym injuries. If you have pain from the gym, or any type of injury, don’t hesitate to get in contact by email at [email protected], call us on 0491 265 859, or book an appointment here.

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