Frozen shoulder, also known as shoulder contracture or adhesive capsulitis, is characterised by stiffness and pain in the joint after the lining around the shoulder becomes raw and inflamed.
The symptoms typically progress over several stages, often described as the freezing, frozen and thawing stage. Its cause is not well understood therefore it is often described as ‘idiopathic’, meaning of unknown cause.
While the condition can clear up by itself over time, the symptoms can be very intrusive in everyday life, meaning many patients seek assistance with treating the condition. Getting treatment earlier can result in a quicker recovery, so get in touch with the team Circle Rehabilitation to find out how we can help you.
To help explain what frozen shoulder is, it’s helpful to think of the joint as a whole. Think of the shoulder as a sealed unit which has a bag around it – this is called the capsule. It is very stretchy and elastic, much like a balloon, which helps with the movement in the joint. With frozen shoulder, this capsule tightens up, starts to lose this elasticity and starts sticking together (hence the name ‘adhesive capsulitis’).
Restricted motion in all directions can develop. This can affect everyday tasks like showering, dressing and even putting a seatbelt on in the car.
With many other shoulder injuries, a physiotherapist will be able to help the patient do passive movements (by moving their arm for them). For instance, with a rotator cuff injury passive movements may not be restricted, so the arm can be moved fully without pain. However, with frozen shoulder there is often no difference between assisted (passive) and unassisted (active) movements, which indicate it could be this condition.
Despite the mystery surrounding the condition, there are three stages to frozen shoulder which are widely used to describe the progression of the symptoms:
Stage 1: Freezing
This first stage might start off with some discomfort and niggling symptoms. The pain will then become more and more intense. Patients often describe it as a ‘catching pain’ which happens when you reach out to get something, but you can still move around at this point. The pain then intensifies further and will become associated with more restricted movement, reducing the amount they can do. This stage typically lasts anywhere between two to nine months.
Stage 2: Frozen
The pain is still there and movement is very restricted in this second stage. Towards the end of this phase, the pain starts to ease a bit but the joint is still getting very restricted.
Stage 3: Thawing
The pain now starts to die off in stage three. The movement gradually starts to improve as the end of the phase is reached.
There are no clear factors which point to causes for frozen shoulder. Many patients suffering with the condition simply develop it for no apparent reason, with no obvious medical history or injuries which may suggest a trigger. Typically, it’s most common in patients aged between 30-50 years old.
However, there are some secondary factors which may be linked. Diabetes could be a factor, as could a trauma or injury in the months leading up to the condition. For example, a patient may have taken a heavy fall and broken their wrists. Some weeks later they may develop some symptoms of frozen shoulder due to the impact. For others however, frozen shoulder may develop by simply knocking into a door accidentally.
An early diagnosis is vital for frozen shoulder, so if you’re worried about some initial symptoms then seeking the help of a physiotherapist is a good start. Getting exercises to do early on can help or even limit the impact frozen shoulder may have. However, if the symptoms have progressed and it’s already really painful, then it’s worth seeking the help of a consultant shoulder specialist who can discuss injection or surgical options if necessary.
Physiotherapists also play a crucial role following surgery, as keeping shoulder mobility is very important. The first priority is to keep the movement the surgery has gained, as the shoulder is instinctively trying to stick itself back down again. Stretching and mobilising the joint up to five times a day, in a strict daily programme, has proved to be an effective way to help patients following surgery.
An effective way to start your exercises is with what we call “passive stretching”. This is where you’re using external forces to help move the shoulder. For instance, a passive stretch would be holding the back of a chair and slowly backing away from it, or using your unaffected arm to move your affected one. This is about helping the stretching and rotation of the arms in a controlled and relaxed way.
Many patients think they will need to use resistance bands to get the most benefit from their exercises. This isn’t the case, at least initially, for frozen shoulder as resistance bands for dynamic stretches are aimed at getting muscles to work effectively. Once other stretching exercises are going well, resistance bands may be used as part of the progression in the physiotherapy programme, to help train and condition the muscles to work effectively in the shoulder.
Typically you can expect to do 10 minutes of exercises, five times a day. This little and often approach is vital to ensure your shoulder stays mobile, while limiting the aggravation the exercises themselves may cause.
The recovery time very much depends on the patient, the history of the condition and what steps they’ve taken to get to a certain point. The time taken for frozen shoulder to pass through each of the three stages (freezing, frozen and thawing) varies a lot, between three to nine months for each phase. Therefore, some patients may recover in a matter of months, but for others the symptoms can last for several years.
A key factor in the recovery is to reduce the pain in the joint, which in turn allows you to do more exercises. Pain inhibits the effective functioning of muscles and can also give patients a fear of hurting themselves further. Some patients haven’t been able to lift their arm from their side for six months or a year, so there’s going to be a natural element of fear and avoidance. If they know a physiotherapist is standing and watching them, this gives them reassurance they’re not going to do further damage. They’ll then take that home with them and further increase their shoulder mobility.
At Circle Rehabilitation, alongside our personalised treatment programmes, we also run circuit classes with 16 stations featuring different exercises. This helps to stimulate the muscles and builds confidence to throw something or pick up an item from the shelf.
If you’ll be seeing a consultant specialist, it’s likely you’ll have follow-ups with the consultant and a physiotherapist too. The team are here to help progress your mobility so you’re able to return to doing the activities and sports you love to do.