Frozen Shoulder?

What is Frozen Shoulder?

• Do you have shoulder pain and loss of shoulder movement?
• Have you been told you have frozen shoulder?

Frozen shoulder is often over-diagnosed (or mis-diagnosed!) and in actual fact is quite rare!

Sometimes shoulder pain and loss of movement is simply due to an underlying bursitis or a rotator cuff tendon impingement (read more about shoulder impingement here!).

Sometimes shoulder pain can simply be caused by arthritis, which is not the same as frozen shoulder. This is why it is essential to see your physiotherapist to ensure you have an accurate diagnosis.

Our shoulder joint has a capsule of tissue that surrounds the joint, underneath the tendons and muscles. In frozen shoulder, the tissue in the shoulder capsule becomes tight and fibrotic which causes a gradual loss of shoulder movement and pain.

True frozen shoulder is described as an insidious inflammatory condition that affects the capsule of the shoulder, significantly reducing shoulder joint range of movement. It can be extremely painful! Insidious means it can start slowly without any known cause! As is is a poorly understood condition, there are many theories as to how this can be caused and also very little forward progress on how best to manage or resolve it.

What should you look out for?

Frozen shoulder commonly occurs in those aged 40-65 years of age. The stiffening of the capsule means that people with frozen shoulder find their shoulder joint becoming progressively stiffer. This loss of movement can occur either suddenly or slowly over a period of time.

This loss of shoulder movement is mainly noticed with twisting or rotational movement and will limit activities such as putting a bra on, reaching behind the back, reaching overhead and out to the side. Equally, frozen shoulder is often extremely painful so look out for severe shoulder pain at the front and side of the shoulder. 

What are the risk factors?

Although we don’t know what specifically causes frozen shoulder, we do know that there are common risk factors associated.

• Type 1 diabetes People with diabetes are 5 times more likely to develop frozen shoulder than people without. Poor glucose control amplifies inflammatory processes that drive frozen shoulder. 
• Genetics Up to 30% of people with frozen shoulder have had a family member who has also experienced it. 
• Adiposity (fatty tissue) 82% of overweight or obese people are diagnosed with frozen shoulder. This can be attributed to the systemic and inflammatory components of metabolic syndrome. 
• Neurological conditions 13% of people with frozen also had a later diagnosis of Parkinsons. 
• Trauma If someone has had a history of trauma such as a fall directly onto their shoulder or on an outstretched hand, their risk of frozen shoulder increases.
• Immobilisation If someone has had their arm or shoulder immobilised such as after a fracture or post operatively, the risk of frozen shoulder is higher. 

How is it diagnosed?

Diagnosis is often a process of elimination, ensuring that other common shoulder conditions are not part of the problem. To ensure a correct diagnosis a physiotherapist will conduct a thorough subjective and objective assessment and may organise with your GP appropriate imaging such as x-rays to exclude osteo-arthritis and/ or ultra-sound scans to exclude tendon or bursal problems.

What can you do about it?

Frozen shoulder has a prognosis of 1-2 years on average before it gradually resolves. If diagnosed early, your physiotherapist can work with your GP or sports medicine physician to arrange medication that can reduce the early inflammation which can help your long term prognosis. This might include oral medication or injections. It is essential you book in with a physiotherapist to maximise your function and minimise your pain during the early stages of frozen shoulder as early diagnosis is helpful. Your physiotherapist will also prescribe exercises to help maintain your strength and mobility as the condition resolves.