What is frozen shoulder?

Frozen shoulder (also known as adhesive capsulitis) is a musculoskeletal (muscle and bone) condition that affects the shoulder joint. It can make your shoulder painful, tight and stiff.

Your shoulder joint includes your upper arm bone (humerus), collarbone (clavicle) and the associated ligaments and tendons. These are contained in a thin covering or 'capsule' of connective tissue.

If you develop frozen shoulder, this capsule becomes thickened and inflamed. Scar tissue forms and makes it harder to move your shoulder.

What are the symptoms of frozen shoulder?

Frozen shoulder usually develops gradually, and progresses through 3 stages:

1. 'freezing'
2. 'frozen'
3. 'thawing'

'Freezing' stage

In this stage, shoulder pain is the main issue, even when you're not moving it. The pain gradually gets worse with movement, making it hard to find a comfortable position, especially for sleeping.

This stage is sometimes described in two parts — the 'painful' stage, followed by 'freezing' or stiffness in the shoulder joint. This stiffness happens as the covering of the shoulder joint becomes 'stuck' to the bones.

'Frozen' stage

In this stage, your pain might begin to improve, although the stiffness remains. You may still feel pain with lifting your shoulder or moving your arm backwards away from your body (external rotation of the shoulder joint).

'Thawing' stage

As the condition improves, you may notice the stiffness in your shoulder joint improves and that you feel very little or no pain.

The duration of frozen shoulder is different for different people. Without treatment, it may take 1 – 3 years.

What causes frozen shoulder?

Sometimes, frozen shoulder develops after a shoulder or arm injury. It can also develop after certain surgeries on the upper body, including shoulder surgery, open-heart surgery or breast cancer treatment. It is more likely to occur in your non-dominant arm.

Often, there is no clear cause of the condition.

You're more likely to get frozen shoulder if you:

• are over 40 years of age
• are female
• have diabetes
• have medical conditions including thyroid problems, Parkinson's disease and cardiovascular disease
• recently had an injury, trauma or surgery, especially if your arm was immobilised

How is frozen shoulder diagnosed?

Your doctor will ask about your symptoms, medical history and any recent injuries. They will examine your shoulder to check for pain and range of motion. Usually special tests, including imaging tests such as x-ray, are not needed to diagnose frozen shoulder.

If your doctor diagnoses frozen shoulder, they may check for other conditions associated with frozen shoulder, such as diabetes, high blood pressure and high cholesterol.

When should I see my doctor?

If you are in severe pain, you should visit your doctor to talk about pain relief and ways to manage your symptoms.

Sometimes your doctor will refer you to a pain specialist or physiotherapist.

How is frozen shoulder treated?

Not much is known about the best way to treat frozen shoulder. Generally, people with frozen shoulder try to manage their pain and stiffness. Most people notice an improvement in their symptoms with the following treatments:

Pain relief

Frozen shoulder can be very painful. Your doctor will discuss different options for pain relief with you. These include regular paracetamol or stronger pain-relief medicines for when your pain is severe. Many pain relief medicines have side effects, so make sure to take them exactly as directed. If you experience side effects that worry you, contact your doctor.

Other strategies some people find helpful include:

• resting the affected shoulder, especially during the early stages of the condition
• icing or warming the painful area
• acupuncture
• taping the shoulder

During the 'freezing' phase, it's a good idea to minimise driving as much as you can, as this can make your symptoms worse. You can make sure that your office chair has armrests to take some of the strain off your arm or place a pillow under your arm to help support it while you sleep.

Physiotherapy

Physiotherapy can be very useful for frozen shoulder, especially in the frozen and thawing stages. Your physiotherapist may suggest strategies to improve your pain and your shoulder's mobility. These vary depending on which stage of frozen shoulder you are currently experiencing.

Your physiotherapist can:

• Advise you about positioning yourself, and other strategies to minimise your pain.
• Give you exercises to improve the movement in your shoulder joint.
• Use manual release (touch, massage, dry needling or trigger point therapy) techniques to improve the mobility in your shoulder joint.

It's important that these treatments do not increase your level of pain. If you experience pain, let your doctor or physiotherapist know so they can make adjustments.

Joint injections

Corticosteroids are a type of anti-inflammatory medicine. Your doctor may suggest corticosteroid injections in your shoulder joint to reduce the inflammation and improve your symptoms. These are considered safe and effective, especially if you have this treatment at an early stage of the condition.

Another technique sometimes used is known as hydrodilatation. This procedure involves injecting your shoulder joint with a sterile saline (salt water) solution. Sometimes, corticosteroid or local anaesthetic is added to this solution. The purpose of this is to 'stretch' your joint capsule and improve the 'freezing' stage of the condition.

Surgical techniques

Surgery can be used to try to 'unstick' the frozen shoulder capsule. This procedure is known as arthroscopy. During arthroscopy, your surgeon will make a few small incisions (cuts) around your shoulder joint to insert a camera and surgical instruments for the procedure. Arthroscopy is usually done under a general anaesthetic.

While you are in surgery, your surgeon may also move and stretch your shoulder joint in specific ways. This is known as 'manipulation'. This treatment can also help improve your pain and stiffness.

Surgery is usually only considered after 6 – 12 months of nonsurgical pain management.

What are the complications of frozen shoulder?

Frozen shoulder can cause long periods of pain and stiffness that affect your day-to-day life. If left untreated, the condition can continue for several years. Even with treatment, it is common to experience symptoms for a long time.

Can frozen shoulder be prevented?

The exact cause of frozen shoulder isn't known, and therefore can't be prevented. Early treatment can help relieve your symptoms and reduce the time until it resolves.

Resources and support

• The Australian Physiotherapy Association has information about the role of physiotherapy in the treatment of frozen shoulder.
• PainAustralia has information about pain services and programs in your area.
• Discuss your pain on the Pain Link telephone helpline (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.
• Musculoskeletal Health Australia offers advice on understanding shoulder pain, or call 1800 263 265.