Adhesive Capsulitis or Frozen Shoulder is the painful gradual stiffening of the shoulder capsule (tissue surrounding the shoulder joint). This painful stiffening leads to disturbed sleep and reduced ability to use your arm for day-to-day activities. The exact cause is unknown but following a minor injury to the capsule the body produces excessive scar tissue as it attempts to heal the capsule. 1 in 20 people are affected and it is more common in women than men. Frozen shoulder mainly occurs between the ages of 40 – 60.
Frozen shoulder is categorised into three phases:
- Painful Phase
- Stiffness Phase
- Thawing Phase
Why did I get it?
The exact cause is unknown but it has been related to an overactive response to a minor injury and attempts to heal the capsule with scar tissue resulting in a stiff painful shoulder. If you have diabetes or have had recent shoulder surgery you are more likely to develop the condition.
What happens to the shoulder when I have a frozen shoulder?
Painful phase – there is increased blood flow to the shoulder capsule to lay down new tissue, this causes pain similar in sensation to toothache and is why the shoulder is more painful at night especially when you lay on it. This phase may last 2 to 9 months (longer in diabetics).
Stiffening phase – scar tissue forms around the shoulder capsule making it difficult to move, during this phase the pain is usually more manageable and sleep is less disturbed. In addition to the stiffness muscles may start to waste as the shoulder is not being used as much. This phase may last 4 to 12 months
Thawing phase – your shoulder will start to loosen and will slowly become easier to move. This happens as the body breaks down unnecessary scar tissue and the capsule becomes more flexible once again. This can last from 5 months to 4 years, in some cases full range may never return
How do I manage it?
Activity modification/relative rest
Activity modification does not mean you stop moving or using your shoulder altogether. Although it sounds straightforward, avoiding activities over your head or behind your back can help to reduce the irritation of your shoulder.
Maintaining good posture
Your shoulder movement can be hugely affected by your posture. If you slouch, your ability to lift your arm above your head reduces by approximately 30 per cent.
Sitting and standing in a good posture with your shoulders back will help your movement as well as prevent the tendons in your shoulder catching. Also try not to slouch and lean through shoulders and elbows. This squashes all the structures in your shoulder against the ridge above the joint, causing pain and irritation.
Simple analgesia and anti-inflammatories
Simple analgesia such as paracetamol can be used to dull the pain but does not cure the problem. Anti-inflammatories such as ibuprofen can also be effective. It is best to consult your health professional, pharmacist or GP if you have not taken these before.
Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for up to 20 minutes every hour. Check the skin under the ice every five minutes to avoid an ice burn. Once the pain begins to settle you can then start to ice your shoulder less frequently.
Injection therapy can be a very effective way of reducing your pain during this stage if anti-inflammatories or ice are having little effect. This can be done by either your specialist GP or by an enhanced role physiotherapist. Injections are not for everyone and may not be suitable for those with certain medical conditions.
Simple range of movement exercises
Please see video of shoulder range of movement exercises by clicking here.