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What is a frozen shoulder?

Shoulder pain is one of the primary reasons why people attend physiotherapy. A frozen shoulder is just one of many possible causes of shoulder pain. If you or someone you know has experienced frozen shoulder, you will be acutely aware of just how debilitating this condition 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 yet fully understood, but to the best of our knowledge at this time, it’s 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;

  1. The freezing phase
  2. The frozen phase
  3. The thawing phase

More recent research has identified that it is not as black and white as we previously thought. It was also believed that it was a self-limiting condition, meaning that it would follow a natural process and recover without intervention. We previously thought this process took about 18 months. 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.


What causes it?

Frozen shoulders can be idiopathic, i.e. without apparent cause. They can also occur following trauma, for example a fall onto the arm, or following surgery such as a mastectomy.

Underlying health conditions such as diabetes and thyroid dysfunction are known risk factors which increase the likelihood of developing a frozen shoulder.


How is it diagnosed?

Frozen shoulders are diagnosed following a clinical examination by a musculoskeletal physiotherapist or doctor. The diagnosis is made based upon the history of onset and through observation of shoulder movement. Sometimes an X-ray, ultrasound scan or MRI is required to help differentiate from other causes of shoulder stiffness.

Shoulder assessment at The Physios

How is a frozen shoulder treated?

There are several treatment options for frozen shoulders. Physiotherapy is typically the 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.

Physiotherapy

Physiotherapy entails a comprehensive programme of recovery. Manual therapy or ‘hands on treatment’ can assist in relieving the pain and restoring the range of movement. This will be backed up with a progressive programme of exercises to ensure recovery. We can also provide advice regarding pain management strategies and sleeping positions. A musculoskeletal physiotherapist will be able to tell you if an injection or hydrodilatation procedure might be helpful.

Steroid Injections

Corticosteroid injections can sometimes be indicated in the management of frozen shoulders. 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 pain relief and more importantly, enable restoration of movement and normal function. It is important to note that here 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 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 with the aim of stretching the joint capsule to break the adhesions, enabling an increase in movement. High volume injections are usually carried out by orthopaedic doctors. They can be useful in cases of more severe restriction and will always be in conjunction with physiotherapy.

Surgery

It is highly unlikely that you will require surgery if you have a frozen shoulder. Surgery is only necessary for a minority of patients when the treatments listed above have not been successful. This is most likely to be the case for people with a more severe restriction and high levels of pain. Surgery may consist of a manipulation under anaesthetic or a capsular release. Post operative physiotherapy will always be necessary after these procedures to maximise the 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.

Injections
Ultrasound guided injection at The Physios

Treatment will then depend upon the irritability of your condition. If the shoulder is very irritable, we may suggest you consider a steroid injection to help to calm the shoulder down, which 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 facilitate the restoration of movement and subsequently function at the shoulder. A programme of specific exercises will help to maintain and improve on any movement gained within the treatment session. These exercises will need to be done regularly (i.e. several times a day) to be beneficial. We can also provide you with advice to help you live with a frozen shoulder, for example 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.

View more articles from Sarah Brownhill (née Crisp)


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