Understanding Frozen Shoulder: Types, Causes, and Treatments, and the Role of Physiotherapy

▫️Written by John Keller

✅ Reviewed by Dr. Jenny Hynes on July 15, 2024

  1. What is frozen shoulder?

  2. Causes of frozen shoulder

  3. Signs and symptoms of frozen shoulder

  4. Diagnostics of frozen shoulder

  5. Treatment options for frozen shoulder

  6. Physiotherapy for frozen shoulder

  7. Conclusion

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. Understanding frozen shoulder is crucial for effective treatment, as it can significantly impact daily activities and quality of life. This condition often progresses through three stages: freezing, frozen, and thawing, each with its unique symptoms and challenges. Early diagnosis and intervention can help manage the symptoms and improve the outcome (Dias et al., 2005; Neviaser & Hannafin, 2010).

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What is frozen shoulder?

Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder capsule thickens and tightens around the shoulder joint, restricting its movement. The shoulder joint is a ball-and-socket joint that connects the upper arm bone (humerus) to the shoulder blade (scapula) and collarbone (clavicle). This joint is surrounded by a flexible capsule that allows for a wide range of motion. In frozen shoulder, the capsule becomes inflamed and stiff, leading to pain and limited mobility (Zuckerman & Rokito, 2011).

Causes of frozen shoulder

 
 

1. Risk factors

Frozen shoulder is more common in people aged 40 to 60, with a higher prevalence in women. Individuals with diabetes are also at an increased risk, as they are more likely to develop this condition and experience a more severe course (Neviaser & Hannafin, 2010).

2. Traumatic injuries

Traumatic injuries to the shoulder, such as fractures or rotator cuff tears, can lead to frozen shoulder. These injuries cause inflammation and scarring in the shoulder capsule, resulting in stiffness and limited movement (Zuckerman & Rokito, 2011).

3. Post-surgical immobilization

After shoulder surgeries, prolonged immobilization can contribute to the development of frozen shoulder. The lack of movement allows the shoulder capsule to contract and thicken, leading to reduced mobility (Dias et al., 2005).

4. Inflammatory conditions

Inflammatory conditions such as rheumatoid arthritis can also predispose individuals to frozen shoulder. The inflammation associated with these conditions can spread to the shoulder capsule, causing it to stiffen and restrict movement (Neviaser & Hannafin, 2010).

5. Idiopathic cases

In many cases, the exact cause of frozen shoulder is unknown. These idiopathic cases can occur without any clear trigger, making it challenging to predict and prevent the condition (Zuckerman & Rokito, 2011).

Signs and symptoms of frozen shoulder

Gradual onset of shoulder pain

The first sign of frozen shoulder is usually a gradual onset of pain in the shoulder. This pain can become severe over time, especially during movement (Dias et al., 2005).

Stiffness and limited range of motion

As the condition progresses, stiffness in the shoulder increases, leading to a limited range of motion. Activities that require overhead or behind-the-back movements become particularly difficult (Neviaser & Hannafin, 2010).

Pain during movement and at rest

Pain is present both during movement and at rest. The constant discomfort can interfere with sleep and daily activities, significantly impacting the individual's quality of life (Zuckerman & Rokito, 2011).

Three stages: freezing, fozen, thawing

Frozen shoulder typically progresses through three stages:

  1. Freezing stage: Characterized by increasing pain and gradual loss of motion.

  2. Frozen stage: Marked by less pain but significant stiffness and limited motion.

  3. Thawing stage: Involves a gradual return of motion, with a decrease in pain and stiffness (Dias et al., 2005).

Early mobilization after shoulder injuries or surgeries

One of the most effective ways to prevent frozen shoulder is early mobilization after shoulder injuries or surgeries. Gentle movement and rehabilitation exercises can help maintain the range of motion and prevent the shoulder capsule from becoming stiff (Zuckerman & Rokito, 2011).

Regular stretching and strengthening exercises

Regular stretching and strengthening exercises are crucial for maintaining shoulder health. These exercises can improve flexibility and strength, reducing the risk of developing frozen shoulder (Dias et al., 2005).

Managing underlying health conditions

Proper management of underlying health conditions, such as diabetes, is essential in preventing frozen shoulder. Keeping blood sugar levels under control can lower the risk of inflammation and stiffness in the shoulder joint (Neviaser & Hannafin, 2010).

Avoiding prolonged immobility of the shoulder

Avoiding prolonged immobility of the shoulder is important for prevention. Regular movement and avoiding positions that restrict shoulder mobility can help keep the shoulder joint flexible and functional (Dias et al., 2005).

Diagnostics of frozen shoulder

Physical examination by a healthcare professional

A healthcare professional will perform a physical examination to diagnose frozen shoulder. This includes checking for pain and evaluating the range of motion in the shoulder (Neviaser & Hannafin, 2010).

Patient history and symptom discussion

Discussing the patient's history and symptoms is a key part of diagnosing frozen shoulder. Understanding the onset and progression of symptoms helps in making an accurate diagnosis (Zuckerman & Rokito, 2011).

Imaging tests

Imaging tests such as X-rays and MRI can help rule out other conditions that may cause similar symptoms, such as arthritis or a rotator cuff tear. These tests provide detailed images of the shoulder joint and surrounding tissues (Dias et al., 2005).

Special diagnostic tests

Special diagnostic tests are used to assess shoulder mobility. These tests help determine the extent of stiffness and pain, confirming the diagnosis of frozen shoulder (Neviaser & Hannafin, 2010).

Treatment options for frozen shoulder

Pain management

Pain management is crucial in the treatment of frozen shoulder. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Ice and heat therapy can also be effective in managing pain and improving shoulder flexibility (Zuckerman & Rokito, 2011).

Activity modification and rest

Activity modification and rest are important to prevent further aggravation of the shoulder. Avoiding activities that cause pain and giving the shoulder time to heal can help manage symptoms and promote recovery (Dias et al., 2005).

Physical therapy exercises

Physical therapy exercises are essential in treating frozen shoulder. These exercises focus on gentle stretching and strengthening of the shoulder muscles to improve range of motion and reduce stiffness (Neviaser & Hannafin, 2010).

Manual therapy and chiropractic adjustments

Manual therapy and chiropractic adjustments can help alleviate pain and improve shoulder mobility. Techniques such as joint mobilization and soft tissue manipulation are used to reduce stiffness and enhance movement (Zuckerman & Rokito, 2011).

Surgical interventions

In severe cases, surgical interventions may be necessary. Shoulder manipulation under anesthesia and arthroscopic surgery are options to release the tight shoulder capsule and improve mobility (Dias et al., 2005).

Physiotherapy for frozen shoulder

Explanation of how physiotherapy helps in recovery

Physiotherapy plays a critical role in the recovery from frozen shoulder. It helps in reducing pain, improving range of motion, and restoring shoulder function through targeted exercises and treatments (Neviaser & Hannafin, 2010).

Types of physiotherapy exercises and treatments used

Physiotherapy treatments for frozen shoulder include:

  • Stretching exercises: To improve flexibility and range of motion.

  • Strengthening exercises: To enhance muscle strength and support the shoulder joint.

  • Manual therapy: Techniques such as joint mobilization and soft tissue massage.

  • Heat and cold therapy: To reduce pain and inflammation.

  • Ultrasound therapy: To promote tissue healing and reduce pain (Zuckerman & Rokito, 2011).

Benefits of physiotherapy

Physiotherapy offers numerous benefits for frozen shoulder patients, including:

  • Improved shoulder mobility and flexibility.

  • Enhanced muscle strength and support for the shoulder joint.

  • Reduced pain and discomfort.

  • Faster recovery and return to normal activities (Dias et al., 2005).

Success stories or case studies

Several case studies demonstrate the effectiveness of physiotherapy in treating frozen shoulder. For instance, patients who underwent consistent physiotherapy sessions reported significant improvements in shoulder mobility and a reduction in pain levels, enabling them to resume their daily activities (Neviaser & Hannafin, 2010).

Conclusion

Recognizing and treating frozen shoulder early is vital for preventing long-term disability and pain. If you experience symptoms of frozen shoulder, seeking professional help is crucial. Physiotherapy can provide effective relief and recovery through targeted treatments and exercises. For personalized care and treatment, contact our physiotherapy clinic to schedule a consultation and start your journey to recovery.

 

References:

  1. Dias, R., Cutts, S., & Massoud, S. (2005). Frozen shoulder. BMJ, 331(7530), 1453-1456. https://doi.org/10.1136/bmj.331.7530.1453

  2. Neviaser, A. S., & Hannafin, J. A. (2010). Adhesive capsulitis: A review of current treatment. American Journal of Sports Medicine, 38(11), 2346-2356. https://doi.org/10.1177/0363546510375479

  3. Zuckerman, J. D., & Rokito, A. (2011). Frozen shoulder: A consensus definition. Journal of Shoulder and Elbow Surgery, 20(2), 322-325. https://doi.org/10.1016/j.jse.2010.07.00

 
 
 

Article by

John Keller

Clinical Director | Sports & Musculoskeletal Physiotherapist

John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.

 
 

Reviewed by

Dr. Jenny Hynes FACP

Clinical Director | Specialist Musculoskeletal Physiotherapist

Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.

 
 
John Keller