Frozen Shoulder

. figure: Frozen shoulder sometimes known as adhesive capsulitis.
Often over or misdiagnosed a frozen shoulder is a painful and stiff joint that can not move beyond 50% of its normal range of movement. A shoulder X-ray will be normal and it is usually of unknown cause or idiopathic.
There are two types of frozen shoulder. Primary or idiopathic frozen shoulder is of unknown cause. It classically occurs in females more than males and in those usually over 45 years of age. It will normally be in the non dominant arm and is more likely to occur in those in a sedentary profession. Secondary frozen shoulder follows significant trauma to the shoulder such as a fracture, dislocation or severe burn. However this injury may have occurred some years previously.
The shoulder joint is surrounded by a capsule, which is like a layer of cling-film covering the joint. It provides fluid to the joint to lubricate it and allow the 360degrees of movement we enjoy in the shoulder. In frozen shoulder it is believed that this capsule starts to shrink and be come stuck or adhere to the shoulder joint. There is some evidence to say that in the early stages this capsule is inflamed and it is sometimes referred to as an adhesive capsulitis. There is other evidence to say that the capsule is not inflamed but that the capsule shortens similarly to that of a Dupuytren's contracture in the hand and that this will have to take its own time to burn itself out.

A frozen shoulder will run 3 stages. Stage 1 is the freezing phase where the shoulder becomes increasingly stiff and painful. Phase 2 is the frozen phase where the shoulder is so stiff that it will not move above shoulder height. This is often the most painful stage and it is then people will usually seek help for the shoulder. It is painful to sleep on and the shoulder usually becomes very sensitive even to small changes in movement. The third and final stage is the thawing phase when the pain reduces and the movement slowly improves.
Each stage of a frozen shoulder will last from 4 to 8 months. Therefore taking anywhere from 1 to 2 years to resolve. Frozen shoulders will solve themselves eventually and will never occur again in them same shoulder. There is unfortunately a 13% chance of it occurring on the other arm, usually within a year of the initial shoulder resolving.
Treatment for a frozen shoulder will vary depending on what stage you are at. In the early phase it is important to try to maintain the movement and control the pain. Anti-inflammatory medication may be useful or even a cortisone injection. There is some debate as to the presence of inflammation in frozen shoulder but research is split on the topic. Physiotherapists can help to control pain and maintain movement.
In the second and most painful stage aggressive manual therapy is counter productive. Patients try a variety of modalities to help ease the pain such as ice or heat or electrotherapy. There is evidence for and against each of these. Whatever works best for the individual should be continued. The aim of treatment at this phase is to control the pain. Acupuncture has been shown to be the most effective. Your physiotherapist may be able to perform this for you or refer you to a suitably qualified person.
In the third phase the pain drifts away and it is then time to get the joint moving. Mobilisation of the joint should be carried out by the Physiotherapist and an exercise program established to get you back to full function.
There are surgical options for frozen shoulder but these are carried out rarely and like everything else in frozen shoulder are debatable. Manipulation under anesthetic is carried out to try to break any adhesions in the joint and kick start the movement. Other more invasive procedures attempt to release the capsule covering the joint in order to free some movement.