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Frozen Shoulder / Adhesive Capsulitis

Frozen shoulder is a complex condition. Initially it presents as a gradually painful shoulder persisting for more than 3 months, which then progressively becomes stiff causing a significant loss in the shoulders range of motion.

The reason a frozen shoulder develops is not fully understood in the scientific literature, but we do understand that there are significant inflammatory processes that occur within the shoulder and the capsule that surrounds the shoulder joint.

We do also know that there are some plausible risk factors which have been identified, these include:

  • Being aged 50 and above.
  • More common in females.
  • Diabetes Mellitus (with prevalence up to 20%)
  • A previous shoulder injury.
  • Thyroid disorder.
  • Other chronic conditions, including: Stroke, Cancer and Parkinson’s disease.

There are generally the 3 stages of a Frozen Shoulder –

Freezing stage – The initial painful phase, pain can often become worse at night. You may start to experience gradual loss of your shoulders range of motion (e.g unable to lift your arms above your head.)

Frozen Stage – Less pain than the freezing phase, but stiffness and noticeable loss of the shoulders motion.

Thawing Stage – The recovery phase, with a gradual return of the shoulder movement and range.

What is the treatment for a Frozen Shoulder:

Physiotherapy, including a tailored strengthening and stretching program, as well as manual therapy where necessary is the key to restoring the shoulders range of motion, strength and function.

Your General Practitioner will also play a significant role in prescribing oral medications such as pain killers and anti-inflammatories, or referrals for ultrasound guided steroid injections or hydrodilatation for which there is strong evidence.

Conclusion
Frozen shoulder does recover in most cases, but can take up to 1-3 years to fully resolve. The evidence shows physiotherapy for arm exercises lead to diminishing symptoms and restoring function in the shoulder.
Given the chronic nature of a Frozen Shoulder, people are often eligible to obtain an Enhanced Primary Care Program (EPC) from their GP to receive 5 government subsidised allied health visits to assist in the treatment of Frozen Shoulder.

References

Favejee, M. M., Huisstede, B. M. A., & Koes, B. W. (2011). Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. British Journal of Sports Medicine, 45(1), 49. doi:10.1136/bjsm.2010.071431

Mezian, K., Coffey, R., & Chang, K. V. (2021). Frozen shoulder. In StatPearls [Internet]. StatPearls Publishing.