Melting the myths on frozen shoulder
Frozen shoulder is an enigmatic condition where for unknown reasons, the shoulder becomes horrendously painful, then progressively stiffens up.
It presents in three fluid overlapping stages:
- The painful / freezing stage – pain limits overhead and sideways movements, effects sleep and all activities of daily living
- The stiff / frozen stage – stiffness is the limiting factor, restricted movement in all planes with pain at end of movement range, unable to lift arm up overhead, around back or out to side
- The recovery / thawing stage – gradual improvement of stiffness and ability to perform activities of daily living i.e. putting laundry out
It was previously thought that a frozen shoulder would spontaneously resolve within 2 years of onset – however recent studies have shown that 41% of people who had not had treatment, still had symptoms 4 years later! Further studies have found physiotherapy treatment and medical management can help shorten the recovery time significantly and get you back doing what you love.
Diagnosis is usually via clinical examination, based on history and movement restriction, with the exclusion of all other potential causes. This is important as it directs best treatment pathway.
The most important aspect of management is education. Your doctor or physiotherapist should discuss the natural history of the frozen shoulder, how to modify activities, and risk versus benefits of treatment options, as well as prescribe the regular performance of a stretching home exercise program graded to your tissue sensitivity level.
The stage of the condition then directs the management pathway: the painful freezing stage may require a cortisone injection or other pain-relieving management, and physiotherapy graded to tissue sensitivity, versus the stiff frozen stage which often requires considerable hands on therapy to improve the stiff range of motion at the shoulder. At the second stage, biweekly sessions are recommended for several weeks in order to achieve lasting improvements in shoulder range of motion.
Surgical release has not been studied extensively, thus should be a last resort when all other treatment options fail, and there is still significant impact on quality of life.
Contact uson 07 5337 9853 if you would like to know more about frozen shoulder!
Lewis, J., (2015) Frozen shoulder contracture syndrome – aetiology, diagnosis and management. Manual therapy. 20:2-9
Wong, C.K., et al (2017) Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 103(1) 40-47
Maund, E. et al (2012) Management of frozen shoulder: a systematic review and cost-effectiveness analysis. 16(11)1-264