Frozen shoulder

Many of us at some time or another may have experienced a problem with one or both shoulders. A common diagnosis is that of a frozen shoulder. Unfortunately this is a term that has been used over the years to describe numerous conditions affecting the upper arm, and has come to mean many things to many people. So, what is a frozen shoulder? How does it occur and what are the symptoms and remedies?

The technical name for a frozen shoulder is a capsulitis. The ball and socket joint of the shoulder is surrounded by a tissue called the capsule. This can become inflamed, resulting in a painful stiffness of all the movements of the shoulder. It occurs most commonly in middle-aged females, although not exclusively. Often a capsulitis may occur following prolonged immobilisation of the arm e.g. after a fracture or secondary to other conditions including a heart attack, Parkinson’s disease or a stroke.

The onset is usually gradual, although it may at times be sudden or even rarely come on overnight. It may occur in one shoulder and then after a variable time involve the other shoulder. However, once an attack has resolved, second attacks of this condition in the same shoulder are rare.

Capsulitis usually goes through four stages:
1) Pain is usually experienced in or around the shoulder joint and is made worse by moving the arm. There is minimal loss of range of movement and stiffness is not usually noticed.
2) The pain becomes more intense, is present at night and often disturbs the sleep. There is difficulty lying on the affected side. Most shoulder movements produce pain which may be felt deep inside the joint or may radiate down the arm to the elbow (or even as far as the wrist). The shoulder becomes increasingly stiff and this painful restriction results in significant disability e.g. dressing, working, driving, housework.
3) There is now little pain at rest, although pain is still experienced on movement, particularly sudden movement. However, the stiffness in the shoulder has become marked due to contracture of the capsule, and the muscles around the shoulder become weak and may waste. It is at this stage that the term frozen shoulder truly applies.
4) Here there is gradual reduction in shoulder stiffness and a gradual return to function in most people.

A shoulder capsulitis may take anything from 9 to 18 months to resolve and it may commence at the second or even third stage. About 20% of sufferers may be left with some degree of residual shoulder restriction.

The management of a capsulitis remains something of a  ‘hot potato’ among the medical profession. One thing is for sure, that it is essential to get a correct and clear diagnosis in the first instance. Arthritis in the joint may have a similar presentation, and muscle or tendon problems can give rise to severe pain in the same area.

Treatment in the initial early stages will consist of rest and pain relief, which may be in the form of anti-inflammatory medication, local injection or physiotherapy modalities such as electrotherapy or acupuncture. Once the pain is settling, movement and exercise are encouraged. Physiotherapy is invaluable to help to restore full function as quickly as is possible.

At 3 Ways Physiotherapy Clinic our experienced Chartered Physiotherapists are on hand to treat all your joint aches and pains. If you feel we can be of further assistance, please contact us on 01202 820044.

© Janine Savage MCSP Chartered Physiotherapist, 3 Ways Physiotherapy Clinic 2011

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