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Frozen Shoulder

Frozen Shoulder - Why does this happen?
The shoulder is a ball and socket joint.  The round head of the humerus sits in a shallow socket on the shoulder blade.  There is a layer of tissue 'The Capsule' surrounding the joint which attaches to the ball and socket.  This helps to hold the joint together.
A Frozen Shoulder or 'Adhesive Capsulitis' occurs when 'The Capsule' becomes irritated and inflamed.  'The Capsule' will tighten as fibrous tissue is formed which results in a loss of movement.
Frozen Shoulder is a condition where the shoulder becomes painful and stiff.
Frozen Shoulder is most common in people between the ages of 40 and 60.  It is 5 times more common in people with diabetes.  About 10% of people with a Frozen Shoulder will also experience the same condition in their other shoulder within 5 - 7 years.  It is not fully clear why people develop a Frozen Shoulder however in some cases the onset of a Frozen Shoulder can be related to a minor injury.
What are the symptoms?
The typical symptoms are pain and persistent stiffness in the shoulder joint.  Activities including dressing, driving and sleeping are usually affected in the early stages.
Symtoms are experienced in three stages:
Stage I - 'Freezing' or Painful Phase (2 to 9 months)
The shoulder starts to ache and feel stiff.  It gradually becomes very painful.  Often it becomes more painful during the night.  Most people will find the pain increases to a point where they are unable to lie on their shoulder.  The pain is usually felt on the outside of the upper arm but it can spread down to the elbow.
Stage II - 'Frozen' or Stiff Phase (4 to 12 months)
The shoulder will become stiffer.  In this stage the level of pain will remain the same as Stage I.
Stage III - 'Thawing' or Recovery Phase (5 to 24 months)
During this phase the movement will gradually improve.  The pain will fade as the stiffness eases.  Although the full range of movement may not return, most people will be able to perform their day to day activities more easily.
Diagnosing a Frozen Shoulder
Your GP or Physiotherapist can usually diagnose a Frozen Shoulder simply by examining your arm, knowing where your pain is and how it started.  X-rays and other investigations are not usually necessary.
What is the treatment?
A Frozen Shoulder will usually get better by itself.  This can take up to 2 years.  There are actions you can take to aid recovery.
During the initial painful stages it is important to manage the pain.  Trying to force movement through the pain has been shown to increase the symptoms and extend the recovery time.
Painkillers and anti-inflammatory medications  -  These may be prescribed by your GP if the pain is constant and you are struggling to sleep.  This is a temporary measure to break the pain cycle, but can continue as required.
Exercise  -  Exercise is useful to help stretch 'The Capsule' which will regain movement.  It is very important not to force movement through the pain.  The shoulder responds well to large rhythmic movements and body weight stretches.  Click here for a list of exercises suitable for a Frozen Shoulder.
Steroid Injection  -  These can be used to reduce inflammation and pain when the symptoms are severe and constant, or if sleep is affected.  This is not a 'cure' and it is important to follow the exercises and modify activities.  A steroid injection in the early 'Freezing Stage' can help break the pain cycle.
Physiotherapy  -  If exercise alone does not improve symptoms or if there is joint stiffness, neck pain or other factors that make doing exercise difficult then physiotherapy treatment may be required.  Click here for more information about Physiotherapy.
Surgery  -  This is not common for a Frozen Shoulder.  In some cases when symptoms are slow to resolve by the treatments above, surgery may be considered.  Manipulation Under Anaesthesia (MUA) involves stretching the joint to free it up and the tight capsule can also be released with Arthroscopic (Keyhole) Surgery.
Remember an important part of treatment for a Frozen Shoulder is your home exercises and modifying activities.