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Frozen shoulder (adhesive capsulitis)

Frozen shoulder (adhesive capsulitis)

Cleaning windows, combing hair or opening bottles – when your shoulder hurts, every movement can feel like agony.

Frozen shoulder is also called adhesive capsulitis. It is a very specific condition which is common and is characterised by pain, stiffness and restricted motion in the shoulder.

Our shoulder experts at Schoen Clinic specialise in the treatment of a frozen shoulder. Together with you, we will discuss all available treatment options to relieve your pain and get you back to enjoying life again.

What is a frozen shoulder?

A frozen shoulder (adhesive capsulitis) is an increasing limitation of movement in the shoulder joint. Patients between 40 and 60 years of age are mostly affected. In thirty percent of patients, both shoulders are affected, but generally not at the same time. Frozen shoulder is ultimately a self-limiting condition. That means it can also heal without medical treatment. A frozen shoulder develops gradually, gets worse and generally heals over the course of one to three years. Ten to twenty percent of those affected, however, retain permanent restrictions.

Symptoms of frozen shoulder

Patients typically experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be focused deep in the shoulder however, it may occasionally be experienced in the upper arm, upper back and neck and you may also experience stiffness in each of these regions.

Patients also typically experience stiffness and significantly reduced range of movement of the shoulder, particularly with motions required for grooming, performing overhead activities, dressing, and reaching behind the back or for the seatbelt. You may also experience pain at night or upon waking in the morning.

As the condition progresses, it often presents three distinct phases. They are the inflammatory phase (freezing phase), stiffness phase (or frozen phase), then a resolution or 'thawing' phase. Each phase may last for months and studies have shown complete resolution can take 8-40 months.

Causes of frozen shoulder

Whilst the exact cause of a frozen shoulder is unknown, the joint capsule often becomes inflamed and symptoms associated with this condition then usually develop gradually over time. It can, however, also develop following a recent history of minor or serious shoulder injury, surgery or period of immobilisation.

It usually occurs from middle age onwards and is very common in people with diabetes and in women. Often both shoulders are affected, separated by a short period of time. Although the underlying cause is unknown the abnormalities noted are a profound inflammation of the lining of the shoulder joint and subsequent scarring and tightening of the ligaments and capsule surrounding the shoulder joint. The inflammation results in pain and the scarring reduces movement.

Diagnostics: how to recognise a frozen shoulder

The diagnosis of frozen shoulder is largely a clinical diagnosis. The onset of pain and symptoms often follows a characteristic pattern. Clinical examination is also extremely valuable. During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your active range of motion. Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both your active and passive range of motion as there is a significant restriction in the shoulder’s range of motion created by a contracture in the shoulder capsule itself. Often the patient notices this as a loss of motion in rotational movements.

Although the diagnosis is largely clinical, your doctor may suggest some tests like X-ray, ultrasound or MRI to rule out other problems.