Frozen shoulder, or adhesive capsulitis, is a painful condition in which movement of the shoulder dramatically reduces. This is a long standing condition, often lasting up to two years.
Usually only one shoulder is affected, however, if you have had frozen shoulder before you are at an increased risk of it affecting the other shoulder at a later date.
The condition is characterised by gradually increasing pain and stiffness affecting the whole shoulder, usually with no attributable cause but occasionally with preceding minor injury. This typically occurs between the ages of 40 and 60, and affects women more frequently than men.
Adhesive capsulitis affects approximately 3% of the population. People with diabetes and rheumatoid arthritis are at elevated risk of frozen shoulder.
There are three stages of adhesive capsulitis;
- Freezing Stage – gradually increasing pain and decreasing mobility, lasting approximately 8 months
- Frozen – severely limited shoulder mobility, although not as painful as freezing stage. Lasts approximately 6 months.
- Thawing – Slow improvements in mobility over approximately 12 months.
Rotator cuff injuries, trapped nerves, rheumatoid arthritis and other conditions can all be confused with adhesive capsulitis, leading to over diagnosis of frozen shoulder. It is therefore essential that frozen shoulder is diagnosed by a specialist such as a chiropractor or orthopaedic surgeon.
There are several treatment options for people with adhesive capsulitis, depending on the stage at which it is diagnosed and the severity of symptoms.
Manual therapy is successful at restoring range of movement and improving pain, however frozen shoulder can be slow to respond and patients may require treatment until the “freezing” and “frozen” stages have passed. Typically treatment involves stretching and mobilisation of the shoulder. A key benefit of manual therapy for adhesive capsulitis is to maintain the function of other joints and muscles that are affected in a compensatory manner in response to the frozen shoulder.
Corticosteroid injection can provide pain relief from adhesive capsulitis and may reduce the duration of symptoms. It does not, however, improve range of movement and therefore should only be used in conjunction with manual therapy. Repeated corticosteroid injections increase the risk of permanent damage to tissues of the shoulder and no more than three should be offered.
Hydrodilation (or capsular distension) is one of the more recent methods of treating adhesive capsulitis. A large volume of fluid containing an anti-inflammatory corticosteroid is injected into the joint capsule causing it to bulge. This is a minimally invasive way of breaking adhesions within the shoulder, thereby increasing range of movement and improving pain. Whilst very effective, this procedure still leaves some stiffness and discomfort. This is likely due to compensations affecting other tissues around the shoulder. Of note, the substitution of hyaluronic acid in place of corticosteroid provides better results and negates the risk of damage from steroid use.
Surgical intervention has also been used in the past. There has been very little research published into whether this provides effective relief of symptoms and the use of this technique is decreasing as it is surpassed by improvements in manual therapy and capsular distension.
Manipulation under anaesthesia should no longer be offered. This is an archaic treatment method in which patients are anaesthetised whilst their shoulder joint is manipulated in a way that would not be tolerable awake. This very successfully breaks adhesions within the shoulder but causes inflammation which results in rapid replacement of adhesions. This method also risks injury to other structures and tissues around the shoulder.
It is important to note that adhesive capsulitis is a chronic (long-lasting) condition and that no treatment will provide immediate or complete relief overnight. Treatment techniques purporting to be cures for frozen shoulder are invariably over stating their benefits.