A shoulder that is stiff and VERY painful to move in most directions. The patient is unable to lift their arm, and the physio is unable to move it for them, usually due to pain. If the Xray is normal, then we suspect FROZEN SHOULDER.

How does it happen?

How frozen shoulders occur is still not fully understood. We know that it is an inflammatory condition that causes eventual contracture of the shoulder joint capsule reducing its volume and restricting movement. The result is difficulty reaching overhead (to wash hair) out to the side (picking a bag up off passenger seat) and reaching behind the back (to tuck in a shirt). We know that the risk factors for developing FROZEN Shoulder include: age> 50, smoking, having type 2 diabetes, being female, having an elevated BMI and leading a sedentary lifestyle.

There are three distinct phases. During the initial freezing phase which may take 3-6 months it is very painful and gradually loses movement. The second frozen stage is less painful but there is significant reduction in upper limb function and the arm loses strength through disuse over 6-12 months. The third stage is the thawing stage where the person notices less stiffness and improvement in mobility, this stage may also take up to 6 months. The whole process may take up to 18 months to resolve.

Treatment Options

The treatment options vary from person to person and may include:

1. Leaving it to resolve on its own, this may take 18 months. Adequate pain relief during the freezing stage helps and lifestyle modifications until it thaws.
2. Physiotherapy to manage pain, guide exercise prescription and provide education regarding prognosis and lifestyle modifications.
3. Cortisone injections during phase 1 may reduce pain and slow progression. Physiotherapy intervention is helpful at this point.
4. High volume hydrodilation during phase one may reduce pain and improve mobility. Immediate Physiotherapy intervention is helpful at this point.
5. Arthroscopic release of the contractures with post operative Physiotherapy to restore strength and mobility is essential post op.

All the above options have pros and cons and depend on the path that the patient wants to take.

Physiotherapy Management

Physiotherapy management includes manual therapy, dry needling and electrotherapies to reduce pain. Exercises to improve strength and mobility. Education regarding the condition and its resolution. Physiotherapists assist the patient to set realistic expectations for recovery timeframes and guide other treatment options.

If you think you may be experiencing Frozen shoulder come in and see a Physio for some advice. We are always happy to listen, talk, examine and get you plan for moving forward for improved shoulder mobility.