Frozen shoulder

What is frozen shoulder?

Frozen shoulder, also known as ‘adhesive capsulitis’, is a condition in which the shoulder joint becomes initially very painful and then gradual stiffening until there is significant restriction in functional movements such as those for every-day tasks and work-related activities. Overhead activities and bringing your hands behind your back can be particularly difficult and if this is the case frozen shoulder treatment is important.

Frozen shoulder progresses through three phases which tend to overlap:

1. Acute/freezing phase – this phase can last anywhere from 3-9 months. Symptoms start with shoulder pain at rest and at night.
2. Adhesive/frozen phase – this phase can occur from about 4 months and last up until 12 months. Pain starts to reduce, and range of movement becomes more restricted. You may only notice pain at end ranges of movement.
3. Resolution/thawing phase – spontaneous improvement in symptoms and range of movement. This phase can last anywhere between 1-3 years.

What causes frozen shoulder?

Frozen shoulder can be either primary or secondary. It is considered primary if the condition has come on spontaneously, with no known cause or trauma, whereas secondary frozen shoulder is often associated with trauma, surgery or other pathology such as subacromial pain.

Ultimately the cause of frozen shoulder remains unclear and is most likely multi-factorial with risk factors including systemic conditions such as diabetes and prolonged periods of inactivity of the shoulder, while it is also more prevalent in women and those aged 40-65.

How can I help myself?

Unfortunately, there is no quick fix for frozen shoulder, but you attitudes and the actions you take are the most important factors in speeding up recovery. The most effective way to manage symptoms of osteoarthritis are to

1. Avoid static positions for long periods of time and keep the shoulder gently active. In the earlier stages of the condition try to maintain your shoulder movement without pushing into pain. As your condition progresses you will find it is not as painful though remains stiff so you can push a bit further to regain movement.
2. Talk to your GP or pharmacist about what pain relief may be right for you. If your pain is controlled (for example, with paracetamol), you will be able to maintain more movement, while anti-inflammatory medication (such as ibuprofen), can help reduce inflammation within the joints.
3. Apply gentle heat (such as a hot water bottle or microwaveable wheatbag) to reduce stiffness, or ice (wrapped in a towel) to reduce pain and inflammation if your shoulder is feeling hot or swollen after activity.

When should I seek further help?

If you suspect you may have a frozen shoulder, contact your GP surgery for further assistance. They may refer you to a physiotherapist who can offer frozen shoulder treatment as follows:

1. Assess your symptoms in order to confirm a diagnosis
2. Help you understand your condition
3. Develop symptom management strategies
4. Provide an individualised exercise program dependent on the stage of your condition to improve mobility then strength of the shoulder
5. Determine whether onward referral may be appropriate, for example for a corticosteroid injection.