A frozen shoulder is without a doubt one of the most disabling conditions one can suffer with. Frozen shoulder sometimes referred to as ‘Adhesive Capsulitis’ is a chronic, inflammatory and painful condition where the shoulder is essentially stiff and range of motion is significantly reduced. The most accurate definition describes frozen shoulder being “characterised by often severe shoulder pain and functional restriction of both active and passive shoulder motion, in which radiographs of the glenohumeral joint are essentially unremarkable.”

In primary (idiopathic) frozen shoulder, the prevalence in the general population is up to 5%. Secondary frozen shoulder however, has a prevalence of 38% in the general population. Sometimes frozen shoulder is referred to as the diabetic shoulder due to the pathology having a prevalence of 46% in diabetics. For long term type 1 diabetes, the lifetime prevalence shoots up to a whopping 76%.

What causes a frozen shoulder is unknown, however there is research that has identified risk factors for its development. Genetics has been shown to be a primary risk factor. Those with a family history of frozen shoulder are 4 times more likely to develop the condition. The estimated heritability of the condition is 42%. As this condition is highly inflammatory, being overweight or obese with increased adiposity has been shown to be another major risk factor. With research showing that 82% of individuals with frozen shoulder are classified as being overweight or obese. The data on sex is conflicting and needs more research, however women have been shown to have this condition at a ratio of 60:40, compared to the male sex. Furthermore, data suggests women are 40% more likely to develop a frozen shoulder then men, with their symptoms also persisting for longer. Parkinson’s disease has also been linked in the research, with 13% of individuals also having a frozen shoulder. Cardiovascular events like a stroke have been linked, with frozen shoulder developing after a cardiovascular accident. An extremely rare risk factor are in those who have been infected with Tuberculosis.

Diabetes as explained earlier though is the major risk factor for a frozen shoulder developing. Those with diabetes are fives time more likely to develop the condition. Additionally, those with diabetes have greater range of motion deficits and their symptoms persist for longer. Type 1 diabetics are also more likely to develop the condition than those with type 2 diabetes. Another hormonal risk factor are thyroid disorders.

Individuals with metabolic syndrome have overall poor health and sustained high levels of inflammation. So it has been suggested that a frozen shoulder is potentially just a symptom of poor metabolic health. This has been strongly linked in the research, with these individuals also having worse outcomes from the condition.

Having general surgery to the shoulder (from all shoulder surgeries) actually had an overall incidence of 11% for developing a frozen shoulder. Age as always plays a part with this condition occurring in those aged 40-65. The average age for the onset of frozen shoulder is 53. Fortunately, a frozen shoulder rarely ever occurs on the same side, however the opposite shoulder can be affected. Data suggests that the opposite shoulder will be affected 17% of the time within 5 years.

What are the symptoms?

A frozen shoulder has previously been thought of as progressing through distinct stages of pathology. However this is not completely true and the stages certainly overlap, with great variance between different individuals.

The condition typically begins with severe shoulder pain and this eventually progresses to significant stiffness. It is located quite globally around the shoulder joint, with it potentially referring down the arm. The pain is characterised by an unrelenting and constant ache, which is often dull. However, fast or unexpected movements can result in a sharp and crippling like pain.

Frozen shoulder does not rest at night, with it always affecting the ability to sleep in most individuals. It is usually in the first few months of the condition that sleep is significantly affected.

The individual will describe difficulty performing simple tasks and will have increased levels of depression and anxiety. Data has shown those with symptoms of depression and anxiety experience reduced function and an increased sleep disturbance.

Treatment

Well this condition is chronic and unfortunately will persist for 1-2 years in most cases. However, there has been plenty of cases where this condition has persisted for much longer than that. Maintaining movement and function whilst managing pain levels is the priority for treatment. The evidence for exercise rehabilitation is positive! Conservative management (exercise rehabilitation) has been shown to be effective in up to 90% of patients!

There are other treatment options like steroid injections and surgery. Surgery as always is the last resort and remember that more than 90% do well with exercise rehabilitation. Interestingly, frozen shoulder is one of the only conditions where director and osteopath Jackson recommends a cortisone shot. Research shows that a single cortisone shot early in the painful phase of the pathology can have positive outcomes to pain and function. The evidence has shown that combining the injection with supervised rehabilitation, results in a significant improvement in pain and function. Furthermore, the combination of the treatment options is more beneficial than one modality alone. The research also shows that two injections are not better than one and exercise rehabilitation reduced the desire to receive a second injection.

This is one of the major conditions that director and osteopath Jackson is extremely passionate about. He has completed further education on this topic, ensuring you are not let down by the medical system. Too often he has seen patients present to him after seeing many health professionals who missed the very obvious diagnosis of a frozen shoulder. At The Reform Lab Osteopathy we have the luxury of managing our patients inside the elite gym Project Reform.

Ensure you read our informative blog ‘Pain and Exercise – Is it safe and beneficial?’