Man grimacing in pain with shoulder highlighted with text bubble saying pain series - frozen shoulder

Frozen shoulder is a common condition, with several contributing factors. Treatment can vary from person to person, but this article will outline the basics of what you need to know.

Shoulder Anatomy

The shoulder involves four joints and many muscles. The shoulder is capable of various movements including flexion, extension, abduction, adduction, rotation and a combination of the above. The movements are able to occur when the joints move together, and the muscles are working smoothly.

What is Frozen Shoulder?

Frozen shoulder is painful loss of shoulder motion, which is most prevalent in people 50-60 years of age. It also tends to affect women more than men.

Stages of Frozen Shoulder

Frozen shoulder tends to follow 3 stages, the initial painful freezing, followed by the adhesive (frozen) stage and finally the resolution (thawing) stage. The three stages can vary in length from one person to another.

Painful "Freezing" Stage [1]:

  • 10-36 weeks
  • Characterized by pain and stiffness
  • Pain usually worse at night, and little response to NSAIDs

Adhesive "Frozen" stage [1]:

  • 4-12 months
  • Stiffness remains. Pain tends to gradually subside, only apparent with extreme movements.
  • Characterized by almost full loss of external rotation

Resolution "Thawing" stage [1]:

  • May last anywhere from 12-42 months
  • Characterized by spontaneous improvement in range of motion
there are 3 stages of frozen shoulder - freezing, frozen, and thawing, which require treatment depending on what stage you're in

How Does Frozen Shoulder Occur?

There are multiple theories as to how frozen shoulder occurs. In a nutshell, it’s believed a few factors are at play.

  • Damage to microcirculation: small blood vessels feed the muscles, cartilage, tendons and connective tissue in the shoulders. If damage occurs to the tiny blood vessels, the surrounding tissues will suffer.
  • Inflammation of synovial fluid with presence of inflammatory cytokines and subsequent fibrosis [1]
  • Fibroblast proliferation followed by cellular transformation to myofibroblasts that would characterize a fibrosing condition[1]

Risk Factors of Frozen Shoulder

  • Chronic shoulder pain: those with a history of bicipital tenosynovitis, rotator cuff tendinitis or complex regional pain syndrome are more likely to develop frozen shoulder if proper precautions aren’t taken
  • Thyroid disease
  • Diabetics (5-6 times more common in diabetics than non-diabetics) [1]

How is Frozen Shoulder Treated?

Treatment focuses on two main categories: pain management and restoration of function

Pain Management

In the initial phase, NSAIDs are commonly used. This is an opportunity to discuss natural pain killers, natural anti-inflammatories, natural fibrinolytics and sleep aids to help with nighttime pain. Discuss with our naturopath to learn more about natural pain management.

Generally: rest, moist heat and proper sleep are important to help with pain management.

Restoration of Function

Physiotherapy is indicated as soon as possible. Avoid aggressive mobilization, as it may prolong the course of treatment [2]. It’s highly recommended to use full range of motion, as restricting movement is detrimental to long term outcomes [1], [3].

Inta-articular cortisone injections

Cortisone shots are usually indicated within the first 6 weeks, beyond that they don’t seem to have any benefit, and they do carry some significant risks and side effects [3]. In either case, physical therapy and natural pain killing should be maintained. Exercise may be stopped for a few days after a shot, but it’s recommended to restart physical exercise within 1 week after injections (to full range of motion) [3].

Oral Glucocorticoids

Are also only effective within the first 6 weeks, and come with significant adverse effects too.

Remember, frozen shoulder usually resovles spontaneously with disappearance of pain and stiffness. However, the degree of pain and restriction as well as the time for recovery will vary drastically based on how it’s treated.

Acupuncture for Frozen Shoulder

Acupuncture  is used for a wide range of physical ailments, including frozen shoulder. Research has actually found acupuncture has immediate improvement on pain score of patients. Furthermore, it was found when acupuncture was added to conservative treatment, acupuncture helped pain but also time to recovery in frozen shoulder [4] [5].

Summary

Frozen shoulder is a relatively common ailment, which sees a somewhat predictable progression through three stages: Painful freezing, Adhesive and Resolution. It’s characterized by pain and restricted range of motion. Physiotherapy, chiropractic, naturopathy and massage therapy can all compliment each other in treating a case of frozen shoulder. Click here to learn more about the clinic.

References

Interested in learning more?

Read on in our series of articles on Joint Health!

About the Author - Sonia Gashgarian

sonia gashgarian physiotherapist

Sonia Gashgarian is a registered physiotherapist who graduated with a Master of Science in Physical Therapy from the University of Toronto. Prior to this she completed her Bachelor of Science in Kinesiology with Honours from the University of Waterloo. Sonia has completed courses in sports taping and basic kinesio-taping, as well as the McKenzie Method of Mechanical Diagnosis and Therapy and Mulligan Concept. She also has her APTEI Acupuncture and Dry Needling Certification.

Sonia uses a variety of treatment techniques to help clients feel better and return to their regular activities as soon as possible. Her individualized treatments may include the following: education, joint mobilizations, exercise prescription, soft tissue release, trigger point release, taping, acupuncture and dry needling, cupping, and Gua Sha.

Too book in please call us at (519) 442-2206 or click here.

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