Frozen shoulder

The shoulder is a ball and socket type joint. The spherical end of the upper arm bone (humerus) rests in the socket of the shoulder blade (scapula). This joint is surrounded by a flexible capsule. The shoulder capsule is fully stretched when the arm is raised above the head and hangs down loose and folded when the arm is by the side. In frozen shoulder the capsule becomes inflamed and sticky and folds of the capsule stick together preventing the capsule stretching and therefore restricting movement of the arm. Frozen shoulder (adhesive capsulitis) also causes pain and stiffness in the shoulder, which reduces normal movement and in some cases all movement is lost. Usually, just one shoulder is affected, but in 20% of cases the condition spreads to affect the other shoulder.

Causes and affected groups

Frozen shoulder is usually found in individuals over 40 years of age. Around 3% of the population will be affected at some stage in their life. The exact causes of frozen shoulder are unknown but there are risk factors that make it more likely to develop the condition.

Shoulder injury or surgery. Immobilisation of the shoulder after injury or surgery may cause the shoulder capsule to tighten due to lack of use.
Poor posture. Rounded shoulders, cause shortening of the shoulder ligaments which may contribute to the condition.
Diabetes. Diabetics are 2-4 times more likely to develop frozen shoulder. Symptoms are also more likely to develop in both of shoulders, and symptoms may be more severe.
Women. Hormonal factors are thought to account higher incidence amongst women
Asians are more likely to develop the condition.
Other health conditions. Increased risk with heart or lung disease, an overactive thyroid gland (hyperthyroidism), post stroke or Parkinson’s disease.

Symptoms of Frozen shoulder

Frozen shoulder is a painful, long term stiffness of the shoulder joint that significantly reduces the mobility of the shoulder.
Symptoms progress slowly and are usually experienced in three stages as outlined below.

Stage one – Painful phase

Gradual onset of aching pain and stiffness, before becoming very painful.
Pain is often worse at night and aggravated by lying on the affected side.
Duration 2-9 months.

Stage two – Adhesive stage

Increasing stiffness with difficulty in performance of everyday tasks
Pain does not normally get worse.
Muscle wasting due to lack of use
Duration 4-12 months

Stage three – Recovery or Thawing stage
Gradually increasing mobility – full range of motion may not be achieved
Pain decreases although it may recur from time to time as the stiffness eases.
Duration 5-12 months

What you can do

Seek help quickly as early intervention can help to prevent long-term stiffness and pain in your joint
Try to keep the shoulder moving within the pain free range
Anti inflammatory medication – speak to doctor or pharmacist about a suitable product

What we can do

Treatment of frozen shoulder varies according to the stage of the condition, and the level of pain and stiffness. The aim of treatment is to control pain and keep the shoulder joint mobile with regular, gentle exercise. Disuse of the shoulder can cause muscles wasting and exacerbate stiffness. Therefore, if you are able you should continue using your shoulder as normal

Prescription of pain free exercises to retain mobility
Physical therapy to maintain flexibility
- Cross friction massage to surrounding tendons to maintain flexibility
- General massage to decrease muscle stiffness
- Myofascial capsular stretches to joint capsule
- Traction and distraction of shoulder