Diagnosis and Treatment
Aidan Rich, APA Sports and Exercise Physiotherapist
Frozen shoulder, also known as adhesive capsulitis, is a common condition that we see at Advance Healthcare.
This condition presents with pain in the upper arm (below the shoulder), which is worse with rotational movements of the shoulder such as reaching behind your body. Prior to the advent of GPS devices, it was eponymously referred to as “Melways shoulder” as reaching into the back seat of the car to get the street directory was one of the most painful activities!
Who is more likely to get frozen shoulder?
This condition is more common in some groups of people:
Aged between 40 and 60
Diabetic
Females (by a ration of about 2:1 to males)
What causes this condition?
Frozen shoulder can occur for no obvious reason (“idiopathic” or “primary” frozen shoulder) or after trauma, such as surgery, a fracture or a fall. This second type is called “secondary” frozen shoulder.
Image 1. A normal shoulder capsule is seen on the left, with the red and thickened capsule on the right
What happens to my shoulder in this condition?
Despite the name, the shoulder is not actually ‘frozen’ and the capsule is not actually adhesed!
We best understand that in this condition, the capsule (lining of the shoulder) transforms from being white, elastic and flexible, to being red (due to new blood vessels), thick and inelastic. Pictures from keyhole or arthroscopic surgery show the difference between a normal shoulder and one with capsulitis (Image 1).
Do I need any scans, such as X-ray or MRI?
Frozen shoulder is normally a clinical diagnosis, meaning that the history and examination findings are all that is needed. Sometimes an X-Ray if performed to exclude other causes of shoulder stiffness such as osteoarthritis.
Will my shoulder get better?
This is a slightly controversial topic, without treatment some shoulders do improve, while others can have symptoms that last for many years. Often the first 3-9 months is the worst time however the condition varies in severity from person to person.
How should I treat this problem?
There are a variety of conservative treatment options available:
Anti-inflammatory tablets have not been shown to be helpful
A trial of prednisolone (a steroid tablet medication) can be helpful in severe cases for short term treatment, particularly if sleep is affected
Stretching and heat may be helpful and are unlikely to aggravate the condition
Massage therapy and manual treatment can give short term benefit although the long term benefit has not been shown
Strength exercises are often helpful with some preliminary research showing benefit for shoulder strengthening (Rawat et al 2017)
Injection therapy is often used for frozen shoulder:
Hydrodilatation is a special procedure where steroid, and up to about 30 ml of saline is injected into the joint. The results from this are generally good to very good, with the improvements in pain being generally greater than improvements in flexibility
An intraarticular corticosteroid injection is similar, but without the saline of the hydrodilatation.
An injection into the subacromial space or subacromial bursa is rarely helpful even if bursitis is shown on imaging
Surgery is a ‘last resort’ for frozen shoulder and in the author’s experience is rarely required. There are a variety of surgical techniques that involve a release of the thickened capsule.
Who should I see for my sore shoulder?
A physiotherapist at Advance Healthcare is an excellent starting point! They can diagnose your shoulder condition and advise you on the best treatment options to help you get back to normal.
Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. He is available for consulting at the Boronia clinic. Bookings can be made via the clinic website or by phoning our friendly reception team on 03 9839 3322. The Boronia clinic is located close to Ferntree Gully, Croydon and Rowville.