Frozen Shoulder
What is Frozen Shoulder?
Frozen shoulder, or adhesive capsulitis, is a common and painful disorder that causes stiffness and loss of range of motion of the shoulder. Frozen shoulder presents as gradually increasing pain and stiffness in the shoulder, usually after an injury or inflammation to the surrounding soft tissues.
What caused my Frozen Shoulder?
It is thought that due to the shoulder not being moved as much due to an initial injury and pain, this leads the connective tissues surrounding the shoulder joint (the joint capsule) to form adhesions 1. Most commonly reaching behind your back and being able to raise your arm overhead become difficult and painful. This can appear very similar to other shoulder injuries, which is why it’s important to have your shoulder examined by a health professional. Imaging, such as X-rays and ultrasound of the shoulder, can be helpful in determining a more accurate diagnosis
How long does Frozen Shoulder last?
Why these adhesions form is still largely unknown, however, the progress of the disease has been well established and is described in three clinical phases:
- Painful phase – development of severe shoulder pain over weeks to months and an increasing level of shoulder stiffness.
- Frozen or adhesive phase – shoulder stiffness and the resulting limitation of shoulder movement continues while the pain slowly starts to decrease.
- Thawing phase – stiffness finally starts to subside and shoulder range of motion slowly returns 2.
The timeframe for each of these phases varies greatly. In the majority of cases, the whole process can take anywhere from 6-18 months and in some cases up to 30 months.
Treatment Options for Frozen Shoulder
There are many options to successfully treat and manage frozen shoulder. These include conservative management (manual therapy such as Osteopathy and exercise rehabilitation), cortisone injection and surgery. Usually conservative management is recommended first, however if pain is severe and worsening then other more invasive approaches are worth considering.
Conservative treatment includes a combination of manual therapy and home based exercises to gently stretch the joint capsule in a controlled way and to then progress to strengthening the surrounding muscles of the shoulder. For some people this can be very effective in shortening the duration of the disease and is helpful in reducing and managing the symptoms of pain and stiffness 3.
Pharmacological treatment options include a technique called a hydrodilatation. This involves injecting a combination of a local anaesthetic and corticosteroid with saline into the shoulder joint to break up the adhesions and decrease the inflammation.
For cases that don’t respond to the above treatment options and who cannot tolerate their symptoms after 12 weeks, surgical treatment options may be considered. These include manipulation under anaesthetic (MUA) and arthroscopic capsule release. MUA involves forcing the shoulder in different directions to help break up any adhesions in the joint while the patient is under a general anaesthetic.
Although research shows similar effectiveness for the various treatment options, what’s important to remember is that frozen shoulder is a self-limiting process. This means, the pain and stiffness caused by frozen shoulder has an end date and generally will improve over time.
The Osteopathic Approach to treating Frozen Shoulder
Forming an accurate diagnosis and determining what stage the disease is in is the first priority. We are then able to choose the most appropriate techniques to directly stretch and mobilise the shoulder.
Due to the painful nature of frozen shoulder, invariably you will experience compensatory pain in other areas related to the shoulder, such as the neck, middle and upper back. We work to ease muscle tension and improve joint function in these areas.
We discuss your diagnosis with you so that you understand how you can help yourself. This includes self management strategies, exercises, and what to avoid. We are able to also advise on when it may be appropriate to consider other treatment options. Book in now and see how we may be able to help you with your shoulder pain.
Frozen shoulder is painful and can be debilitating. However, with tailored advice and management strategies we can help you can work through this self-limiting disease process successfully.
References:
1) St Angelo JM, Fabiano SE. Adhesive Capsulitis. [Updated 2021 May 10]. StatPearls Publishing; 2022 Jan
2) Ramirez J. Adhesive Capsulitis: Diagnosis and Management Am Fam Physician. 2019 Mar 1;99(5):297-300
3) Silva, R., Pimentel, A. and Gutierres, M., 2021. A literature review of the treatment options for Idiopathic Adhesive Capsulitis of the Shoulder. Orthop Spo Med Op Acc J, 4, pp.460-8.
