Frozen shoulder is characterised by a painful and stiff shoulder. The lining (capsule) of the shoulder becomes inflamed and stiff, causing shooting pain with certain arm movements such as lifting the arm.
In most cases, it comes on gradually however, it can also come on without warning. Pain can be triggered by lifting, twisting, reaching back or injury to your shoulder.
Generally, it starts with dull pain around shoulder and upper arm which increases in severity over time and you may feel excruciating pain with certain arm movements like hanging up your washing, combing hair. The pain can be severe enough to wake you up from sleep at night.
The common risk factors include stress, lack of regular exercise, post menopause, diabetes, some cardiovascular conditions, post shoulder injury or post shoulder surgery and some gastric cancer and epileptic drugs.
3 Phases of Frozen Shoulder:
The natural course of frozen shoulder consists of 3 phases. These phases can vary in duration person to person. They also overlap most of the time.
- Freezing: Initially pain develops around the shoulder and upper arm, which increases in severity over time. It gets worse at night. Shoulder stiffness may start to develop. This phase can last up to 4-9 months.
- Frozen: During this next phase, pain might reduce, but stiffness worsens. There may be difficulty moving the shoulder in a way that restricts day to day activities. This phase can last from 4 months to a year.
- Thawing: In this last phase shoulder range of movement starts to improve. The duration of this phase hugely varies and according to research it lasts from 4 months up to several years.
A Physiotherapist or GP will be able to diagnose frozen shoulder after a physical examination. They will check movements of your shoulder joint actively and passively and do special tests to rule out other conditions. Your GP may order some imaging tests like X-ray, Ultrasound or MRI to rule out other conditions such as rotator cuff pathologies.
The treatment of frozen shoulder depends on whether you are in a pain dominant or a stiffness dominant phase. In the early stage, injections of corticosteroids or hydrodilatation (injecting fluid/corticosteroids to stretch the shoulder joint capsule) can help with pain especially night pain.
Evidence suggests that doing simple shoulder mobility and strengthening exercises with respect to pain can help you with recovery. A rehabilitation program may reduce the duration of the three phases of frozen shoulder. It is important not to push through pain. Your Physiotherapist can provide you some manual physiotherapy techniques and exercises prescriptions to help you with your pain and stiffness.
Written by Hiral Buch, Physiotherapist