Frozen Shoulder

Frozen shoulder is a relatively common condition that can have a significant impact on a person’s life. A person with a true frozen shoulder usually experiences a significant loss of motion and experiences a significant amount of pain.

About Frozen Shoulder

Frozen shoulder affects approximately 2-5% of the population. Also called adhesive capsulitis, frozen shoulder can be linked to certain health conditions (such as diabetes or rheumatoid arthritis) but not always. For many patients, frozen shoulder occurs for no apparent reason.

Why is my shoulder stiff?

The precise mechanism of frozen shoulder is still relatively unknown. That being said, it is generally understood that some form of “event” causes the cells in your shoulder to change their activity. Inflammation likely causes the different tissues in the shoulder to contract or “bear down” on the joint. As a result it is very difficult to move since there is a type of “debris” in the way.

Symptoms of Frozen Shoulder

A person with frozen shoulder will likely experience pain when they move their shoulder to the end of available range. Often, the shoulder won’t hurt with movement in a short range and will not really hurt at rest. Contrary to popular belief, the muscles are not damaged or weakened in any significant way. Although it seems like the muscles must be damaged or torn, they usually aren’t. The joint just won’t move!

Tests for Frozen Shoulder

Unlike many conditions, there really aren’t any imaging findings for a practitioner to look for. When a person presents to our clinic with pain, loss of movement and no obvious findings on x-ray, diagnostic ultrasound or MRI, frozen shoulder is a diagnostic possibility.

One movement that gets reduced during frozen shoulder, is internal rotation.  Do you have difficulty with the movement shown below?

Frozen Shoulder

Frozen Shoulder

Phases of Frozen Shoulder

It’s important for people with frozen shoulder to realize the expected healing rate (according to the published literature).  Although some lucky individuals recover from their frozen shoulder relatively quickly, many patients experience symptoms for over a year. According to the literature, the first phase of frozen shoulder lasts approximately 3-9 months. This is the “freezing” period which involves progressive pain and loss of motion.

Second Phase of Frozen Shoulder

The second phase of frozen shoulder occurs between 9-15 months since onset. At this point the shoulder is stiff…frozen shoulder has arrived!

Recovery from Frozen Shoulder

The last phase of frozen shoulder is often referred to the “thawing” phase. It can often occur between 15-24 months and involves a relatively gradual improvement in mobility.

Treatment for Frozen Shoulder

The treatment for frozen shoulder really depends on the phase of development and the amount of pain the patient is experiencing. Conservative treatment (like chiropractic or physiotherapy) is usually recommended and involves such things as stretching, assisted stretching, active release technique and other forms of manual therapy, laser therapy, interferential current, graston and acupuncture. Sometimes a combination of these approaches does the job. For those with very painful frozen shoulder, corticosteroid injections can be helpful. Surgery is also an option for those who fail to respond to conservative treatment (like physiotherapy or chiropractic). Unsure if you even have a true frozen shoulder? Want to know your options for treatment?

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Favejee M, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 2011; 45: 49-56.
Johnson AJ et al. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy 2007; 37(3): 88-99.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 135-148.