“How do I WARM IT UP?”
The exact cause of Frozen shoulder, or as it is formally known as, ADHESIVE CAPSULITIS, remains unclear. It is believed to be secondary to the formation of adhesions in the joint capsule or capsular contraction that results in pain and inhibition of movement through the shoulder(1).
The reason many refer Adhesive Capsulitis as “frozen shoulder” is due to the presentation of the symptoms. There is an insidious onset of pain through the glenohumeral (shoulder) joint, followed by a gradual reduction in the range of motion and movement which ultimately results in severe stiffness through this joint(4). Many people report that this process feels like their shoulder is “freezing and then becomes frozen”.
Consequently, this can interfere quite significantly to people’s activities of daily living as it extremely limits or even inhibits the use of the affected shoulder; especially regarding overhead activities such as hanging washing on the line.
Although the exact cause and etiology of frozen shoulder remains unclear, there have been multiple risk factors identified that are associated with this condition(4).
• >50 years of age
• Early menopause or post-menopausal
• Diabetic disorder
• History of shoulder trauma or surgery
Frozen shoulder reduces the area of the shoulder joint capsule and thickens it five-fold
Although there is no clear physiological boundary of phases that identify the different presentations of adhesive capsulitis, It is common to distinguish some of the key features into the ‘3’ Phases of Frozen Shoulder:
Shoulder PAIN is the primary complaint
Including Night pain
Pain inhibits full shoulder range of motion (in the capsular pattern)
A swollen shoulder capsule
No loss of strength or stability
Lasts approximately three months
Shoulder STIFFNESS is the primary complaint
Shoulder capsule has contracted
Reduction in the pain severity
Global loss of shoulder movement
Lasts approximately 4-12 months
Shoulder stiffness gradually subsides
A graded return to shoulder range of movements (in the reverse capsular pattern)
Can take up to 2 years in duration
Do I Jab it, or Rehab it?
There is a range of treatment options offered for this condition; however, two of the most commonly utilised interventions are:
This form of treatment is multifactorial and involves patient education, stretching exercises, range of motion exercises and mobilisations(2). Early intervention is shown to reduce the natural history and severity of Frozen shoulder(2). Conservative management varies depending on the current stage of the condition.
CORTICOSTEROID INJECTIONS (CSI):
CSI in the early stages of phase 1 is key to reducing the natural history and severity of Frozen shoulder(3) as it limits the development of the adhesions within the capsule and reduces local inflammation(3). The intra-articular CSI can work well in conjunction with appropriate conservative management(3).
Simple Steps to a Safe & Speedy Recovery
Freezing phase 1:
Avoid aggravating activities (1)
Focus on pain relief modalities (e.g. heat, NSAIDS)(2)
Pendulum Exercises: Gentle range of motion exercises (low intensity and duration) and very gentle stretches(2)
Seek advice from a healthcare professional including that of potential corticosteroid injection (2)
Frozen phase 2:
More aggressive mobilisations with movement and stretches (as tolerated by the patient)
Low load stretches with increased duration)(1)
Attempt to resume function and improve range of motion(1)
Soft tissue (as tolerated) to the adjacent and local musculature
Thawing phase 3:
Promote the progression of natural history by actively partaking in active and passive range of motion exercises
If you or anyone you know suffer from adhesive capsulitis, best to see your local practitioner.
Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331(7530):1453-1456.
Kelley M, Mcclure P, Leggin B. Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(2):135-148.
Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation. 2008;22(6):503-512.
Walmsley S, Rivett D, Osmotherly P. Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique. Physical Therapy. 2009;89(9):906-917.