Frozen Shoulder

What is Frozen Shoulder? see pictures​​

This is a condition in which the capsule of the shoulder joint becomes inflamed and thickened. This results in pain, stiffness and restriction of shoulder movement. This condition is also known as adhesive capsulitis. It is more common in women between the ages of 40-65 years.

What are the symptoms?

You may have frozen shoulder if you experience pain and stiffness when:

  1. Lifting your arm, ether straight out in front or sideways.
  2. Rotating your arm, such as when unzipping the back of your dress or reaching for objects in your rear pocket.
  3. Shampooing and dressing.
  4. Sleeping on the affected shoulder.​


What causes frozen shoulder?

The exact cause is unknown. The condition has been linked to auto-antibodies that attack the joint capsule, resulting in inflammation, adhesion and eventual scar tissue formation. It may be triggered by injury (including surgery), degenerative changes in the joint, as well as viral illnesses. This condition is also more common in diabetics. Your shoulder may go through several stages as the scar tissue forms, with each stage lasting between three to six months:
  1. Freezing stage – you may experience ache and mild stiffness as the disease starts. Pain worsens as the condition progresses.
  2. Frozen stage – pain diminishes but stiffness increases. Shoulder movements can be severely restricted.
  3. Thawing stage – shoulder movement improves, and you will be able to do more activities. Complete resolution is the norm but up to 15% of patients may have remaining movement restriction or weakness.
What will my doctor do?

After a physical examination, an ultrasound scan and X-ray may be required to exclude other causes of pain. In the early stages, it may be difficult to tell it apart from other painful conditions affecting the shoulder.

How is it treated?

The disease will, unfortunately, have to run its course. The goal of treatment is to minimise pain and discomfort during the disease process and to restore full range of motion and strength by the end of its natural course. Your doctor may prescribe a course of anti-inflammatory medication for symptom relief. Forceful manipulation should be avoided as this may worsen symptoms. Hydrodilatation of the joint may be required in severe cases. During this procedure, which is carried out under local anaesthesia, a small volume of sterile solution is injected into the joint to loosen adhesions.

To maintain shoulder function, you are encouraged to perform the exercises shown. Each exercise should be performed at least twice a day. Application of a warm towel for 5-10 minutes prior to exercise will reduce the discomfort. Exercise both shoulders, so that you can also maintain movement in the healthy shoulder. If there is increased pain after exercise, ice the painful part for 5-10 minutes.

Range of motion (ROM) exercises see pictures

Assisted internal rotation
Assisted abduction
Assisted forward flexion
Scapular retraction

Stretchessee pictures

Cervical, chest & shoulder stretch
Posterior capsule stretch

What is my prognosis?

Many people with frozen shoulder regain full use of their shoulder after the condition has run its course. However, this may take 6-18 months from the onset of symptoms, and there may be some remaining pain and stiffness. Recurrence, either in the same shoulder or the other side can happen.​