What is a frozen shoulder?
Shoulder pain is one of the main reasons people attend physiotherapy. A frozen shoulder is one of many possible causes of shoulder pain. If you or someone you know has experienced a frozen shoulder, you will be very aware of just how debilitating it can be. Read on to learn more about the condition and how we can help.
What is a frozen shoulder?
The medical term for a frozen shoulder is ‘adhesive capsulitis’. Frozen shoulders are characterised by pain (typically in the upper arm region) and progressive stiffening of the shoulder joint. The condition is not completely understood, but it is thought to be due to a combination of inflammation and scar tissue formation within the joint capsule (a fibrous structure that surrounds the shoulder joint).
Classically, it was thought that all frozen shoulders transition through three distinct stages on their road to recovery;
- The freezing phase
- The frozen phase
- The thawing phase
More recent research has identified that it is not as black and white as we previously thought. It was also thought that it would follow a natural healing process over about 18 months, and recover without treatment. There is now increasing amounts of evidence to suggest that unfortunately for some people, the condition can take up to 3 years or more to recover and that certain interventions can expedite the process.
What causes it?
A frozen shoulder can be idiopathic, i.e. without apparent cause. They can also occur following trauma, for example if you fall onto the arm. Or, if you have had surgery such as a mastectomy.
Conditions such as diabetes and thyroid dysfunction may increase your risk of developing a frozen shoulder.
How is it diagnosed?
If you have shoulder pain and suspect a frozen shoulder, you should see a musculoskeletal physiotherapist or doctor. They will carry out a clinical examination. A diagnosis will be made based upon your history of onset and through observation of your shoulder movement. Sometimes an X-ray, ultrasound scan or MRI is required to help differentiate from other causes of shoulder stiffness.
How is a frozen shoulder treated?
Physiotherapy is typically your first port of call. This may be in conjunction with a steroid injection or hydrodilatation procedure. It is unlikely that you will require surgery if you have a frozen shoulder.
You can read in detail about physiotherapy treatment below. But in short, physiotherapy will consist primarily of a combination of ‘hands on treatment’ and progressive exercise. This will help to reduce pain and regain movement. A physiotherapist will also provide advice regarding pain management strategies and sleeping positions. They will also tell you if an injection or hydrodilatation procedure might be helpful.
A corticosteroid injection may be suggested by your physiotherapist. As discussed above, there is an inflammatory element of adhesive capsulitis. Cortisone (steroid) is part of a group of drugs that have strong anti-inflammatory properties. Tackling the inflammation can provide you with pain relief and help restore your range of movement and function. It is important to note that at The Physios, we do not offer injections as a stand alone treatment. We strongly encourage that any cortisone injection is accompanied by physiotherapy to ensure you the best recovery. You can read more about shoulder injections or our injection service by clicking the links.
High Volume Injections – Hydrodilatation/Hydrodistension
Hydrodilatation/hydrodistension, involves injecting a relatively large volume of liquid (a combination of saline and corticosteroid) into the joint. The aim of this is to stretch the joint capsule to break the adhesions. This can enable an increase in movement. Hydrodilatation can be useful if you have a severe loss of movement or have not responded to an initial cortisone injection. Physiotherapy will always follow to ensure your best recovery.
It is highly unlikely that you will require surgery if you have a frozen shoulder. Surgery will only be necessary when the treatments listed above have not been successful. This will only be appropriate if you have a very severe restriction and/or high levels of pain. Surgery consists of a manipulation under anaesthetic or a capsular release. Post operative physiotherapy will always be necessary after these procedures to maximise your potential outcome.
How can The Physios help?
The team at The Physios are musculoskeletal experts. One of our physiotherapists will carry out a detailed clinical assessment and will be able to identify whether your shoulder pain is the result of a frozen shoulder or a different shoulder condition. They will tell you whether any imaging such as an X-ray is necessary. Occasionally, an ultrasound scan can be helpful to aid the diagnosis. We have the ability to undertake this at the clinic.
Treatment will then depend upon the irritability of your condition. If your shoulder is very irritable, we may suggest you consider a steroid injection to help to calm the shoulder down. This should enable you to then tolerate hands on treatment and exercise. We have a team of physiotherapists that can offer cortisone injections ‘in house’.
If your shoulder isn’t too irritable (or once you’ve had an injection), treatment will consist of a combination of manual therapy and rehabilitative exercises. The goal being to restore your range of movement and improve function at the shoulder. You will be shown a programme of exercises to maintain and improve your movement following on from the treatment session. These will need to be done regularly during the day to be beneficial. We will also provide you with advice to help you live with a frozen shoulder. This may include advice regarding appropriate pain relief and sleeping positions.
If you require a prescription for pain relieving medication, we have therapists who are Independent Physiotherapy Prescribers and can provide you with a private prescription if getting an appointment with your GP is a problem.
Think you might have a frozen shoulder?
Let us take a look. Give us a call on 0114 267 8181 or book an appointment online now.