Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis (frozen shoulder) is a shoulder condition affecting mainly the 40-60 year old age group and more commonly in people who have diabetes. 1 in 50 adults are likely to be affected at some point in their lives. It often starts without cause or can be triggered by an injury to any part of the arm. The main structure affected is the capsule (lining) of the shoulder.

The capsule of the shoulder is important for the lubrication and nutrition of the joint and also to provide stability. With adhesive capsulitis the lining initially becomes very inflamed and painful. This is often referred to as the freezing stage. The frozen stage often follows where the capsule begins to scar and tighten. The pain often reduces during this stage but movements become restricted. Finally the thawing stage occurs where the lining heals, pains reduces and movement returns. This whole process can take up to 2 years but can be shortened and made easier with the correct physiotherapy treatment.

• Age. Common in 40-60 year olds.
• Health. People with diabetes are more likely to suffer with adhesive capsulitis.
• Underlying shoulder injuries, commonly impingement problems
• Recent trauma to any part of the arm may trigger a frozen shoulder, including fractures and surgery to any part of the arm
• There may be a link to people who have a history of Dupuytren’s contracture in their family (a connective tissue disorder of the hand) 

• Pain. Ranging from mild to very severe, the pain is often felt in the top of the arm and into the elbow. It can occur with movement or at rest. Nighttimes are often the worst time to experience pain causing problems sleeping. There is also pain associated with many shoulder/arm movements making even dressing and feeding difficult.

• Reduced movement. Rotation movements are particularly affected making reaching into trouser pockets, fastening bras and reaching out to the side extremely difficult. In some cases these actions become virtually impossible to do.

If a frozen shoulder is diagnosed early enough it is possible to reduce the pain and loss of movement significantly. An experienced physiotherapist can diagnose a true frozen shoulder quickly and begin the appropriate course of treatment. This involves specialised stretches, soft tissue mobilisations and a specific home exercise programme aimed at keeping the capsule as flexible as possible. Painkillers may be needed at this stage for a short time. If the condition is particularly aggressive, surgery may be indicated which is then followed by intensive physiotherapy. In either case most people make a very good recovery and return to full function.