Injuries and conditions

Frozen Shoulder

Frozen Shoulder

Frozen shoulder most commonly affects people between the ages of 40- 60, and occurs in women more often than men (2:1). The cause of frozen shoulder is not known and patients usually present with pain and shoulder stiffness. Initial treatment is usually non-surgical, with a period of rest followed by guided physiotherapy. Thankfully, after a period of worsening symptoms, the frozen shoulder tends to spontaneously improve; however full recovery may take 1-2 years. In a small number of cases surgery may be required to expedite recovery, relieve pain and/or treat other coexisting conditions (such as a traumatic supraspinatus tendon tear).

Frozen shoulder (also referred to as adhesive capsulitis) presents with pain and stiffness in the shoulder; often without any trauma or incident.

In a frozen shoulder, the shoulder capsule thickens and becomes stiff and tight. The thick bands of tissue (adhesions) develop within the shoulder joint limiting movement.

The classical presentation of frozen shoulder is initially intense pain and then progressively being unable to move your arm. Often there is no history of trauma or any other illness.

2 medical diagrams comparing a normal shoulder and a frozen shoulder

There are three stages of a frozen shoulder

Freezing

  • In the freezing stage, you slowly have more pain. As the pain worsens, you lose shoulder range of motion.
  • This stage typically lasts anywhere from 6 weeks to 6 months (usually it’s 1-3 months)
  • There is no role for physiotherapy at this stage
  • A guided cortisone injection into your shoulder joint may offer some pain relief

Frozen

  • The painful symptoms may subside during this phase
  • The hallmark of this stage is stiffness and reduced range of motion
  • This stage typically lasts anywhere from 3 to 6 months
  • You may find daily activities very difficult during this phase
  • There is no role for physiotherapy at this stage
  • If you are very stiff, then a hydrodilation may be of some benefit (although the evidence is limited)

Thawing

  • This is the home stretch and the final stage
  • During this phase, the shoulder range of motion gradually improves and pain has subsided
  • Physiotherapy can be useful at this stage
  • Complete resolution of range of motion can take up to 2 years in some cases

The causes of frozen shoulder are not fully known; there is no clear connection to arm dominance or occupation. There are a few risk factors, however, that put you at increased risk of a frozen shoulder.

Frozen shoulder commonly occurs in those aged between 40 and 60, and occurs in women more often than men. In addition, people with diabetes and thyroid disorders are at an increased risk of a frozen shoulder. There are three phases of a frozen shoulder: painful, stiff and thawing out. Each phase case lasts 2-3 months.

It is important to correctly diagnose frozen shoulder and exclude any other pathology: such as rotator cuff tears or shoulder joint arthritis. For this reason, younger patients may benefit from an MRI scan. However, most of the diagnosis is made on history and clinical examination.

The natural history of a frozen shoulder is good and patients generally improve over time. Some patients may benefit from a cortisone injection into the joint. Physiotherapy is a useful addition once the shoulder starts to thaw out. Occasionally, surgery is needed to free up the capsule to allow better range of movement.

Frozen shoulder surgery is reserved for patients whose range of motion is going backwards at 6-9 months into a frozen shoulder. It is also suitable for those who are found to have a time urgent issue on the MRI scan (such as an acute rotator cuff tear or biceps tendon dislocation).

2 medical diagrams comparing a normal shoulder capsule with a the inflamed and thickened shoulder capsule and ligaments of a frozen shoudler

With careful patient selection the results after capsular release for frozen shoulder are good to excellent. It is vital that immediate physiotherapy commences post-surgery to prevent scarring of the released capsule.

Patient results

Frozen Shoulder Release

This gentleman in his 60s suffered from a frozen shoulder for almost a year; his symptoms were unrelenting and he failed to improve over time despite non-surgical treatment. Examination and MRI imaging confirmed ongoing frozen shoulder as well as biceps tendonitis, subacromial bursitis, and AC joint arthritis; thankfully his rotator cuff was intact. 

He underwent arthroscopic frozen shoulder surgery (capsular release) and a biceps tenodesis, subacromial decompression and excision of his AC joint. Range of motion exercises were commenced immediately after surgery using the JPL protocol.

Request a call back

"*" indicates required fields

Alternatively, if you have any further questions or would like a consultation with Dr Pant get in touch:

Medicare Card Help

1. Medicare Number
2. Position on card
3. Expiry Date

Request a call back