Adhesive Capsulitis – Frozen Shoulder
Updated: Aug 14
Signs and Symptoms
- Gradual onset of pain in the shoulder
- Increasing restriction in shoulder range of motion
- Pain in the shoulder and upper arm, sometimes radiating down the arm
- Active range of motion and passive range of motion both equally restricted
What is it?
Frozen shoulder, also known as adhesive capsulitis, is an abnormal inflammatory process of the shoulder causing excessive scar tissue to form. This leads to the joint capsule thickening and sticking to itself and the humerus (your arm bone), giving you a functional loss of both active (controlled by you) and passive (controlled by an external force) range of motion.
Frozen shoulder typically goes through three phases, and in total can take up to a year or more. Phase 1 is the ‘freezing’ stage, in which there is a large inflammatory process within the shoulder and proliferation of inflammatory molecules. Phase 2 is the ‘frozen’ stage in which scar tissue has begun to form and you reach peak stiffness of the shoulder joint. Phase 3 is the ‘thawing’ stage in which the inflammation has settled down and the shoulder stiffness begins to resolve.
Diagnosis of a frozen shoulder is often made clinically by thorough physical examination, observation of the shoulder changing over time, and can be augmented by ruling out other pathologies radiologically. X-rays can help rule out osteoarthritis and calcific tendinosis, and MRI scans can observe the soft tissues around the shoulder joint to identify any tears, inflammation of the bursae and may or may not observe signs of a frozen shoulder through thickening of the joint capsule.
What causes it?
The cause of frozen shoulder is often unknown and is not well understood. However, there are several risk factors that have been linked to the pathology. Diabetes has been associated with frozen shoulder, with up to 20% of the diabetic population experiencing one at some point in their life. Comparing these numbers to the 2-5% of normal healthy adults that experience a frozen shoulder should give you plenty of motivation to a healthy diet and regular exercise to reduce your likelihood of developing diabetes. Other risk factors related to our body systems include being postmenopausal, hyper or hypothyroidism and hypoadrenalism.
Frozen shoulder can also occur post-trauma, such as in cases of rotator cuff or biceps tendon tears, after shoulder surgery, after shoulder fracture or with cervical disc disease.
How can Physiotherapy help?
Upwards of 90% of patients will make a full recovery with non-operative management. While intervention generally doesn’t stop the course of a frozen shoulder, it can help improve the function of your shoulder for the 12-24 months you are experiencing it. Physiotherapy interventions include joint mobilisations, soft tissue massage, stretching and strengthening exercises.
Here are some examples of stretches we use to help improve the function of your shoulder:
1) Flexion stretch with a pulley
2) External rotation stretch with a dowel
3) Internal rotation stretch with a dowel
Another intervention that may help improve your function is a hydrodilatation injection which you can have once a frozen shoulder is confirmed. This can be performed in a radiology clinic and can be referred by your GP.