Frozen Shoulder Coventry & Birmingham

Frozen shoulder or Adhesive capsulitis is a painful condition mostly affecting people aged 30-70. It is estimated that 3% of population will develop the condition in their lifetime. There is no known racial preference; however, adhesive capsulitis is associated with certain conditions, particularly insulin-dependent diabetes.

What causes a frozen shoulder?

Frozen shoulder is the result of inflammation, scarring, thickening, and a reduction of the capsule that surrounds the normal shoulder joint. Any injury to the shoulder can lead to frozen shoulder, including tennis elbow, tendonitis, bursitis, and rotator cuff injury. Frozen shoulders occur more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder.

Predisposing factors of Frozen Shoulder

There are multiple risk factors predisposing an individual to developing a frozen shoulder. These predisposing factors may include, shoulder or neck surgery, diabetes, shoulder trauma, or inflammatory conditions. Other systemic conditions such as cervical cancer, autoimmune diseases and hypotyriodosm (underactive thyroid) may also to be linked to the condition.

What are the symptoms of frozen shoulder?

• Shoulder pain; usually a dull, aching pain
• Limited movement of the shoulder
• Difficulty with activities such as brushing hair, putting on shirts/bras
• Pain when trying to sleep on the affected shoulder

What are the stages of frozen shoulder?

Painful/Freezing Stage

This is clearly the most painful stage of a frozen shoulder. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts 6-16 weeks.

Frozen Stage

During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last 4-9 months.

Thawing Stage

The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

How frozen shoulder is diagnosed

Diagnosis of frozen shoulder is made basing on symptoms and on physical examination of the shoulder. The use of Digital X-rays may show abnormalities such as narrowing of the joint and reduced bone density; however in early phases of adhesive capsulitis, the shoulder joint appearance in Digital X-ray is normal.

How is a frozen shoulder treated?

The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent.

Diligent physical therapy is often the key and can include ultrasound, electric stimulation, range-of-motion exercise manoeuvres', ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is very important for people with a frozen shoulder to avoid re-injuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.

Frozen Shoulder May be Resistant to Treatment

Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anaesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.

• Frozen shoulder is the result of scarring, thickening, and a reduction of the joint capsule.
• Any injury to the shoulder can lead to frozen shoulder.
• A frozen shoulder is will be diagnosed during an examination.

Probable Outcomes

The residual symptoms of pain or stiffness are often present even after completion of course of conservative therapy. However, functional disability is rare. A frozen shoulder may require aggressive treatment and an exercise program.

Low Level Laser Treatment of Frozen Shoulder

Cold or low level laser therapy is now used in treating this condition and is employed by us at Central Chiropractic & Physiotherapy Clinic. Physiotherapy treatment combined with Cold or low level Laser Therapy is extremely effective in reducing both shoulder pain and restricted movement. At present this type of treatment is not available within the NHS.

Treatment usually combines use of anti-inflammatory drugs to relieve pain and inflammation with intermittent applications of heat and ice packs. Exercises are prescribed to build strength and improve movement and it is important to persist at these because recovery is gradual but slow. In some cases steroid injections into the joint may be needed. In severe cases the affected shoulder may need to be manipulated under anaesthesia before an aggressive rehabilitation program can be commenced.

Cold or Low Level Laser Therapy (LLLT) is a hand-held, non invasive, light-emitting medical device which is used over different areas of the body. It provides an unmatched advantage in the treatment of conditions such as frozen shoulder. For further information on Cold or Low Level Laser Therapy, visit our pain relief section.