Frozen shoulder (adhesive capsulitis) is a shoulder condition characterized by restricted movement, stiffness, and pain. It is slightly more common in women and usually affects people over the age of 50.
Frozen shoulder does eventually resolve without treatment, but it takes a long time.
What causes frozen shoulder?
We do not know what causes frozen shoulder – it is classified as an idiopathic condition.
We do know, however, that there is fibrosis and contracture of the joint capsule of the gleno-humeral joint.
The gleno-humeral is the ball-in-socket joint of the shoulder and is responsible for most of the shoulder movement.
What are the symptoms of frozen shoulder?
Frozen shoulder is often falsely self-diagnosed because many people assume they have frozen shoulder if they struggle moving their arm.
True frozen shoulder, though, is only present when the joint capsule of the ball-in-socket joint shortens. Otherwise, pain and limited range of movement can be due to a myriad of other shoulder problems. These include rotator cuff injuries and subacromial impingement, biceps tendinopathy, shoulder osteoarthritis, rheumatoid arthritis, and polymyalgia rheumatica.
It is important to note that frozen shoulder is limited to the shoulder. If you simultaneously develop knee or neck pain, you may be presenting with something else. In any case, if you are unsure, you should see a specialist – for example your GP or osteopath.
Frozen shoulder typically comes in three stages – the painful stage, freezing stage, and the thawing stage.
Painful stage:
- lasts 2-9 months
- nocturnal pain, not related to activity, progresses to constant pain at rest
- range of movement not yet restricted
- in this stage, frozen shoulder is difficult to diagnose
Freezing stage:
- lasts 3-9 months
- pain may start to decrease (pain usually lasts 1-2 years before subsiding)
- range of movement becomes limited
- For GPs and osteopaths, frozen shoulder is easy to diagnose in the freezing stage because, unlike other shoulder conditions, both active and passive movement are restricted.
Also, the restricted vectors are very specific – combined lateral rotation and abduction, as well as medial rotation and extension.
Thawing stage:
- lasts 1-3 years
- pain progressively decreases and is only felt at extreme end range
The loss of movement in frozen shoulder is usually very debilitating and can interfere with sleeping, combing hair, cycling, and driving.
Who gets frozen shoulder?
Only 3% of adults will have frozen shoulder at some point in their lives.
You are likelier to get frozen shoulder if you:
- are over 50
- are female (1.4:1)
- have Parkinson’s, diabetes mellitus type-1, or hyperthyroidism
- have had frozen shoulder in the past (about 20% will develop frozen shoulder on the other side at some stage)
What treatments are there for frozen shoulder?
Even if you have no treatment at all, there is a very high chance your shoulder will get back to normal. But different treatment approaches are likely to speed up recovery. Here are some options:
Shoulder exercises
Shoulder exercises are safe and easy to do and can be recommended by a physiotherapist or osteopath. The aim is to maintain as much shoulder movement as possible.
Physiotherapy or Osteopathy for frozen shoulder
As mentioned above, physios and osteopaths can prescribe shoulder exercises.
In addition to this, physios may try TENS machines, and osteopaths will address the wider area. This includes the neck, the other shoulder joints and muscles, and the nerve supply to the shoulder.
Both physios and osteopaths may also use ultrasound therapy.
Pain-killers
Paracetamol can dampen the pain during the painful and freezing stages. Taking too much paracetamol can compromise the liver.
Anti-inflammatory painkillers
Anti-inflammatory painkillers, such as ibuprofen, diclofenac and naproxen, can dampen the pain. However, anti-inflammatory painkillers come with side effects, such as irritating the stomach lining and the kidneys. Therefore, I do not recommend the use of NSAIDs, even over-the-counter, if it can be avoided.
In any case, you should not take anti-inflammatories for more than a week or two. If you are, speak to your GP or pharmacist.
Steroid injections
A steroid injection into the shoulder can provide pain relief for a few weeks. The remission is short-lived, however, and steroid injections come with risks.
The procedure can damage tendons, introduce infection to the shoulder, and cause bleeding.
Surgery for frozen shoulder
Sometimes, none of the treatments work and the shoulder does not recover after a considerable amount of time. In such cases, you may consider the following operations.
- Manipulation. The shoulder is mobilised by the surgeon under local anaesthetic. This will loosen up the adhesions and stretch the joint capsule but can damage other structures of the shoulder.
- Arthroscopic capsular release. This is a keyhole surgery in which the joint capsule is released with a special probe.
Because of the risk of making matters worse, surgery for frozen shoulder should be avoided until all else fails.
Can osteopathy help frozen shoulder?
Frozen shoulder usually resolves on its own but can take a long time. With treatment, you should expect faster improvement.
Often, the best approach is to do shoulder exercises, keeping the shoulder as mobile as possible, and seeing a specialist, ideally an osteopath.
An osteopath will try to mobilise the shoulder within the non-painful range in order maintain and increase mobility. This will ensure no new adhesions are formed that will compromise the shoulder.
Also, osteopaths are best-placed to treat the wider area, including the neck, nerve supply, and other shoulder joints. This will ensure shoulder movement is not impeded by other nearby dysfunctions.
In addition to this, some osteopaths have access to ultrasound therapy which can help frozen shoulder. I would recommend checking this with your osteopath because not all practices do.
At the Aston Clinic London in New Malden we have an ultrasound machine.
So, if you believe you may have a frozen shoulder, please get in touch.
To book an Osteopathy appointment in New Malden or in Marylebone, phone 020 8942 3148 or contact Aston Clinic London.
Aston Clinic London is a third-generation complementary health clinic based in New Malden and serves the local areas of Kingston, Wimbledon, Raynes Park, Surbiton, Chessington, Worcester Park, Sutton and other areas of southwest London and Surrey.
Aston Clinic London also offers Osteopathy and Herbal Medicine in Marylebone, Central London.
