Frozen shoulder – or adhesive capsulitis, as it’s known technically – is a condition I see among a small percentage of my patients.
In technical terms, adhesive capsulitis means there is an inflammation (capsulitis), resulting in tissue thickening and adherence to other tissues (adhesive).
While it’s a generalisation, it is a condition found most often in the non-dominant arm of middle-aged women working in desk-bound roles.
Frozen shoulder is like other shoulder conditions – and it’s not.
Although it can mimic other shoulder injuries, the medical profession defines frozen shoulder as pain and loss of motion in the shoulder from no other cause.
Any wonder it’s frequently misdiagnosed by patients and professionals alike.
There are a few myths (and many misdiagnoses) with frozen shoulders, and like most myths and all misdiagnoses, they’re not at all helpful.
Let’s clear them up so you can move closer to understanding what a frozen shoulder really is.
What Causes Frozen Shoulder?
Rarely the result of injury, frozen shoulder kind of creeps up on people with little or no warning.
The first a patient may know about the condition as a gradual onset of pain. This is followed by stiffness demonstrated in the loss of external rotation of movement (ROM) in the shoulder.
If a patient has become aware of the condition, and can’t nominate any other potential cause (e.g. diabetes, trauma, injury, recent surgery), there’s a chance frozen shoulder is the issue.
Correct diagnosis is not a complex process.
Relying heavily on direct questioning of the patient, most genuine cases can be diagnosed by listening to the patient and review of simple x-rays.
In these consults, I will always ask patients about conditions like diabetes, thyroid problems, and their history of stroke or cardiac disease.
A physical examination classically reveals external rotation has been compromised.
Frozen shoulder should not be confused with simple capsulitis caused by an injury or other physical cause.
By contrast, simple capsulitis is inflammation in the shoulder lining, the pain of which prevents arm movement.
How is Frozen Shoulder Treated?
It may sound overly simple, but treatment for frozen shoulder relies initially on counselling and realignment of the patient’s expectations.
It is very common to see people with frozen shoulder who feel demoralised about the condition.
Frozen shoulder doesn’t have quite the same profile as a shoulder injury gained through sporting adventures. It’s for this reason mainly that I’ve observed many patients arrive in my treatment rooms with very limiting beliefs.
After correct diagnosis, my first task is always to reframe these preconceptions.
I find that once they’ve been informed with accurate information and timeframes for healing are discussed, most people leave feeling better – about the condition and their management of it.
It’s also my practice to share the wisdom and experience of my colleague and friend, Professor JP Warner from Harvard University in Boston. Referencing his website, which has great information, I’ve found the majority of people gain real confidence about their likely outcomes, just by having more knowledge and reasonable expectations.
What is most helpful for these people is the understanding that frozen shoulder passes through three phases. The duration of these phases varies. Healing a frozen shoulder can take between four and 20 months.
I’ve summarised my typical approach to treatment at each phase in the table below:
Note, these phases are rarely discrete, meaning there will often be an overlap between them. At each step of the recovery journey, I encourage patients to ‘listen’ to their shoulder.
Quite simply, this means, if you’re still experiencing significant pain, don’t do anything to ‘fix’ it. Working through the pain can make things worse.
The good news is, the majority of patients with frozen shoulder get better on their own. My approach is to rest during the painful phases and only commence physio once the second and third phases have commenced. I tend to advise patients to trial less invasive treatments first and only resort to invasive procedures like hydrodilatation after consulting a shoulder specialist.
Hydrodilatation is a procedure during which fluid is forced into the shoulder until the lining (capsule) bursts. Frequently very painful, and no guarantee of success, I tend to avoid this approach.
If after treatment a patient remains unhappy with their shoulder movement, an arthroscopic capsular release may be warranted.
This is performed as keyhole surgery. It is a procedure wherein adhesions (scar-like tissue) and the connective tissues around the capsule are released. You can find more information about the procedure here.
With frozen shoulder, there is no one size fits all remedy, making it important your focused shoulder specialist assesses your particular case on its merits.
Dr Sommit Dan is a leading Adelaide shoulder specialist. He provides minimally invasive and more complex treatment for all shoulder injuries and conditions. An Australian trained orthopaedic surgeon and highly skilled in arthroscopic (keyhole) shoulder reconstructions, rotator cuff repair and shoulder replacement surgery, Dr Dan treats patients as people. His goal is to his patients navigate the frequently challenging roadmap to recovery, empowering them along the way.