Also known as adhesive capsulitis, is an insidious painful condition of the shoulder persisting for more than 3 months. This inflammatory condition that causes fibrosis of the glenohumeral joint capsule is accompanied by gradually progressive stiffness and significant restriction of range of motion (typically external rotation). However, the patients may develop symptoms suddenly and have a slow recovery phase. The recovery is satisfying in most cases, even though this may take up to 2 to 3 years.
What you may feel if you have a frozen shoulder?
There are three phases that you may experience when you have a frozen shoulder. They are the freezing phase, frozen phase and thawing phase.
The typical symptoms comprise a passive and active range of motion restriction, usually rotating the arm out to the side or elevating the arm from the side. The impairment would restrict the activities of daily living, working and leisure activities. You may experience difficulties in personal hygiene, clothing and brushing hair. Sometimes you may experience neck pain because of overuse of cervical muscle to compensate for the loss of shoulder motion.
Treatment
Freezing phase
The aim should focus on pain control, reduction of inflammation and patient education. Initial treatment options for adhesive capsulitis may include acetaminophen or NSAID. Although evidence regarding NSAIDs for the treatment of frozen shoulder is limited, they can be prescribed to provide short-term relief from night pain if present. However, in severe cases, opioid analgesics may be required.
Physical therapy is important for pain control and restoration of normal shoulder mobility. Physiotherapists would use soft tissue mobilisation and gentle stretching to control the pain and help the range of motion. Physiotherapy management should also focus on therapeutic exercise. However, not everyone would be able to tolerate mobilisation exercise in the initial stage of the frozen shoulder due to severe pain. A supervised therapeutic exercise should be conducted to slow down ROM restriction.
Frozen Phase
After the inflammation-related painful period settles, the condition progresses to a frozen phase. The treatment objective should focus on regaining ROM limitation. Physiotherapy treatment should continue joint mobilisation and stretching to restore mobility. Strengthening exercises should be started in the form of isometric/static exercises. You can apply heat/ice packs for pain relief after the exercise/treatment.
Thawing phase
In this phase, you should experience gradually regaining the range of motion of the shoulder joint. You have to continue doing the stretching exercise to progressively increase/maintain the range of motion. Strengthening exercise should be progressed from isometric/static to resistance-based strengthening exercise.
Summary
|
| Freezing | Frozen | Thawing |
Duration | 2-9 months | 4-12 months | 5-26 months |
Signs and Symptoms | Gradual onset of diffuse, severe shoulder pain Worsens at night
| Pain begins to subside Progressive loss of range of motion | Gradual return of range of motion |
Conservative Treatment | Patient Education Medication: NSAIDs Physiotherapy | ||
Physiotherapy treatment | Gentle Stretching Exercise Heat/ice pack | Maintain Stretching Exercise Strengthening Exercise – Isometric/static Heat/ice pack | Maintain stretching exercises Strengthening exercise – progress from isometric to resistance based |
Reference list
Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Chan, H., Pua, P. and How, C., 2017. Physical therapy in the management of frozen shoulder. Singapore Medical Journal, 58(12), pp.685-689.
Written by Derek Lau (Physiotherapist)