Adhesive capsulitis, more commonly known as ‘Frozen shoulder’, refers to the sudden onset of severe shoulder pain that later progresses to an extremely stiff and immobile shoulder.
More common in females than it is men (3:1) and in those aged between 40-60, it affects around 2.5% of the population. There is a wide variety of causes that can be categorised below:
- Primary – idiopathic onset, meaning there is no clear reason for the onset
- Secondary – more common and follows on from pre-disposing factors or previous episode of shoulder pain/injury
A secondary onset can also be split into 3 sub-categories:
- Systemic conditions: metabolic, cardiovascular, inflammatory, genetic conditions
- Extrinsic factors: low physical activity, fractures, previous stroke, Parkinson’s
- Intrinsic factors: shoulder trauma, shoulder surgery, rotator cuff pathology, shoulder infection
What does a Frozen Shoulder look and present like?
Firstly, as always, it is best to seek a thorough examination from a physiotherapist to rule in or out a frozen shoulder – but here are some ways to help spot it.
If you have likely googled what a frozen shoulder is before you may have come across the ‘typical’ 3 stages.
- Stage 1 = “Freezing”
- This is when usually pain levels are the main limiting factor to movement, rather than stiffness
- Stage 2 = “Frozen”
- This is now when pain levels may start to ease and as you push the shoulder towards its end range, it is more the stiffness that is limiting than the pain
- Stage 3 = “Thawing”
- This stage is now where everything starts to ease off, pain levels may be low and stiffness is much reduced, but underlying movement deficits may still be present, so it is important to still work closely with your physio at this stage
This 3-stage outline is a good way to look at how the whole process of a Frozen Shoulder looks; however, it is not always as clear or as distinct as this.
Typically, you have a sudden onset of extreme, severe shoulder pain that has either happened out of the blue or after a trauma (such as a fall or rotator cuff tear). Pain is high, you are very easily irritated and has been often described as “excruciating” when moved too suddenly.
Pain is often wide-spread and can’t be “pin-pointed”, and you are likely to have severe restrictions to your mobility and therefore your general day-to-day activities (undressing, washing, reaching overhead etc).
It would still be advised to seek professional attention as other conditions may also present with severe pain and restriction to shoulder mobility:
- Shoulder osteoarthritis
- AC joint dysfunction
- Sub-acromial bursitis
- Parsonage-Turner Syndrome
- Rotator cuff pathologies
How do you treat a Frozen Shoulder?
Firstly, treatment is very individual and based on the person’s own goals. However, in the early stages soft tissue release and massage is commonly used to the surrounding muscles to help settle and alleviate pain. Exercise therapy is used throughout to reduced pain and promote range of motion – however these should be specific to your presentation to have the best overall affect and long-term outcome.
Here are a few examples of early-stage exercises that may help manage your pain and movement better:
PENDULUMS: a great way to provide some distraction within the shoulder joint. Perform 10-20 repetitions 2-3 times a day.
ISOMETRICS: keeping your arm in by your side, push in/out in different directions to activate the different muscles surrounding the shoulder joint. Hold a contraction for 10s each and repeat 2-3 times a day
Other ways to self-manage your condition include:
- Hot packs
- Pain medication
- Improving lifestyle factors: diet, smoking, weight, stress
How long will this take to get better?
Unfortunately, this is the hardest part for most to understand with a condition like this. Typical online material may suggest 12 to 18 months to fully recover however in our experience here at Physioflexx along with a vast amount of research, it could take up to 30 months to resolve.
That may seem like a long and daunting prospect; however, it is our job as physiotherapists to maximise your rehab. It may take up to 30 months, but that does not necessarily mean 30 months of severe pain. Again, each individual is different but it is extremely important to manage expectations early on so that you and your physio can make the appropriate plans going forward.
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