Frozen Shoulder
What is a Frozen Shoulder?
Frozen Shoulder (also known as Adhesive Capsulitis) is a condition characterised by stiffness and pain in the shoulder joint, leading to a gradual loss of motion.
Stages of Frozen Shoulder:
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Freezing Stage: Gradual onset of pain that worsens over time, leading to decreased shoulder movement. This stage can last 6 weeks to 9 months.
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Frozen Stage: Pain may reduce, but the shoulder becomes stiffer, severely limiting motion. This stage typically lasts 4 to 12 months.
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Thawing Stage: Shoulder movement gradually improves as stiffness decreases, taking 6 months to 2 years.
Mechanism of Injury:
Frozen shoulder often develops without a clear cause but is associated with prolonged immobilisation (e.g., after surgery or injury), diabetes, and other systemic conditions. It occurs when the shoulder capsule thickens and tightens, forming adhesions that restrict movement.
Symptoms
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Pain: Persistent, dull, or aching pain in the outer shoulder or upper arm, often worse at night.
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Stiffness: Severe limitation in shoulder movement, making daily activities difficult.
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Limited Range of Motion: Difficulty in raising the arm, reaching overhead, or behind the back.
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Weakness: Reduced strength due to disuse and pain.
Treatment
Immediate Treatment:
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Pain Relief: NSAIDs like ibuprofen or paracetamol to manage pain and inflammation.
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Heat Application: To relax the muscles and reduce stiffness.
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Gentle Movement: Avoid complete immobilisation; perform gentle stretches within the pain-free range.
Clinical Treatment:
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Physiotherapy: Focuses on stretching and strengthening exercises to improve shoulder mobility and function. Specific exercises target the rotator cuff and scapular stabilisers.
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Manual Therapy: Mobilisation techniques to stretch the shoulder capsule and reduce stiffness.
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Corticosteroid Injections: May be used to reduce inflammation and pain, especially in the early stages.
Surgical Treatment:
If conservative treatments are ineffective, surgical options include:
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Manipulation Under Anaesthesia (MUA): The shoulder is forcibly moved under anaesthesia to break adhesions.
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Arthroscopic Capsular Release: Minimally invasive surgery to cut through tight portions of the shoulder capsule.
Post-surgery, a structured rehabilitation programme in the clinic is essential to regain shoulder mobility and strength, typically involving intensive physiotherapy.
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