Conditions
Adhesive Capsulitis, or Frozen Shoulder as it is commonly known, can happen after trauma (fall, fracture), after prolonged immobilisation such as post-surgery, or spontaneously. It is more common in females than males and mostly occurs in the range of 40 to 60 years of age. If occurring spontaneously it is frequently in the non-dominant limb.
Frozen shoulder is a thickening in the capsule (ligaments) around the shoulder joint with inflammation on the inside lining of the capsule. It results in a loss of both passive and active range of motion of the shoulder, with associated pain and stiffness. Symptoms generally begin gradually with increasing pain and stiffness and progresses through 3 stages.
- Painful (freezing) stage
- Starts with pain but then develops stiffness
- Pain with any shoulder movement
- Pain often worse at night
- Progressively limited range of motion
- No response to anti-inflammatory medication
- Frozen stage
- Pain begins to subside
- Range of motion remains significantly limited
- Thawing stage
- Range of motion begins to improve
- Most, if not all range of motion will return
Progression through the 3 stages takes anywhere from 18 to 36 months.
Frozen shoulder, especially in the earlier stages is often misdiagnosed as bursitis or impingement. Correct diagnosis allows appropriate treatment and commencement of a rehabilitation program. Given the symptoms vary from mild to severe, the management varies as well. Exercises to maintain range and often reduce pain are advised as long as they are well tolerated.
Overall, management is difficult and prolonged. Conservative exercises to maintain comfortable range of motion is the predominant approach. There are a range of additional treatment options including:
Hydrodilatation injection into the shoulder joint to stretch the capsule and reduce inflammation
Manipulation under general anaesthetic
Surgery to release thickened capsular tissue and remove inflammation
Discussion with your physiotherapist is advised regarding the above options. If further information is required, then consultation with our affiliated shoulder surgeons can be arranged. The good news is this is rarely required and good management, patient compliance and patience, results in an excellent outcome.