Frozen shoulder is a painful and markedly stiff glenohumeral joint - the main ball-and-socket joint of the shoulder.  

The medical term is "adhesive capsulitis".

Three Stages of Frozen Shoulder

Frozen shoulder occurs spontaneously, often following a minor shoulder sprain or strain. Pain and stiffness begins gradually, worsens over time, and spontaneously improves.  

We describe it progressing through three stages:

• Freezing / Painful Stage:
  • Pain with movement.
  • Difficult to sleep because of pain.
• Frozen Stage:
  • Often less painful.  
  • Marked stiffness of the joint.  
  • Limited range of movement.
• Thawing Stage:
  • ​​Gradual improvement in range of movement.

Each stage can last 6 - 12 months, so the natural progression of frozen shoulder takes 18 months to 3 years.  

Pain in the shoulder comes from inflammation of the joint capsule. As the shoulder stiffens we see the capsule thicken with fibrotic adhesions and a loss of volume of the joint fluid.

Unfortunately once you have recovered there is a 20% chance of getting a frozen shoulder in the other arm or the same arm again.

Who Gets Frozen Shoulder?

Frozen shoulder will affect 3% of the population. Frozen shoulder affects females more than males, the left shoulder more than the right shoulder, and is most common between 40 and 60 years of age. It is more common in people who have diabetes and/or thyroid disorders.

Treatment

Frozen shoulder is self-limiting and will improve spontaneously with time. We expect a recovery of 90% of the range of movement, which is enough for day-to-day activity without noticing any limitations.

In the mean time, treatment is aimed at relieving symptoms:

• Over-the-counter or prescription medications can be used for pain relief.  
• Physiotherapy can offer gentle massage, dry needling, and kinesiology taping for pain relief.
• Physiotherapy encourages maintaining the current range of movement with pain free range-of-movement exercises.  
• The most important thing is to use the arm as much as possible in day to day activities (without aggravating the pain).
• There are some injectables that may not get the shoulder better any faster but can help relieve discomfort in the short term.

Hydrodilatation is a treatment for frozen shoulder that is performed more in Melbourne than Sydney. A large volume of fluid is injected into the joint capsule to make it rupture, followed by a stretching program to maintain the increased range of movement.

Post-Operative Shoulder Stiffness

Glenohumeral joint stiffness can also occur as a complication of shoulder trauma or surgery. Often the shoulder needs to be immobilised for a period of time following trauma, during which the shoulder joint structures can weaken and tighten from disuse. When it’s time to start moving again the shoulder it is stiff and painful.  

Glenohumeral joint stiffness following shoulder trauma will improve over a 6 - 12 month period with exercises that can be prescribed by your physio.

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