Frozen Shoulder

In short

• With frozen shoulder you have shoulder pain that often extends into your upper arm
• The pain gets worse and worse and your shoulder becomes stiff and immobile
• At first, it only hurts when you move but as the condition progresses, your shoulder continues to hurt even when you are not using it.
• Frozen shoulder is caused by inflammation within - and later also around - the joint capsule (this is the connective tissue that surrounds the joint)
• Frozen shoulder almost always gets better by itself but it can take a very long time
• It is good to keep the joint mobile within your pain threshold
• Physiotherapy is an effective treatment for frozen shoulder
• It is important to note that shoulder pain is not always a sign of frozen shoulder!

What is frozen shoulder?

Frozen shoulder is shoulder pain that gets worse and worse. The pain is caused by inflammation within the joint capsule (the connective tissue that surrounds the joint). Over a period of a few weeks to months, you find it increasingly difficult to move your shoulder as the joint capsule tightens and becomes immobile. The shoulder becomes ‘frozen’. This stiffening of the shoulder can restrict your range of movement in any direction. If your range of movement is reduced in at least three directions, you are considered to have frozen shoulder.

Causes of frozen shoulder

Between 2 to 5% of the Dutch population develop frozen shoulder. The condition is more common among women than men and most people who get frozen shoulder are between the ages of 40 and 60. Sometimes frozen shoulder can occur after a fall or surgery, but often there is no obvious cause. People with diabetes mellitus, thyroid disease, epilepsy, Dupuytren’s contracture, cardiorespiratory disease and/or Parkinson’s disease are more likely to develop frozen shoulder. Recent research suggests that prolonged stress can also play a significant role.

Symptoms of frozen shoulder

Frozen shoulder typically progresses through three stages:

The pain and freezing stage: This initial stage lasts an average of a few weeks to nine months. The shoulder pain gradually gets worse and can be very severe. The pain can extend into the upper arm and even into the forearm. Daily activities such as dressing and undressing, reaching up to get things from cupboards and driving are painful and may cause sharp shooting pain. You experience constant pain even when you are not moving and at night. Your upper back and neck may also hurt. Your shoulder becomes increasingly stiff. It is not wise to force your shoulder at this stage. Overly aggressive movement will only cause you more pain.

The frozen stage: This stage lasts an average of four to nine months. The shoulder pain gradually lessens but the loss of movement remains. You can slowly increase the intensity of your exercise.

The thawing stage: This stage lasts an average of four to twelve months. There is no longer any pain and movement slowly returns to (close to) normal.

Treatment of frozen shoulder

Frozen shoulder usually gets better by itself but it can take a very long time: anything from ten months to more than three years. Expert advice and treatment from a physiotherapist can play an important role in the healing process. Together with your physiotherapist you can identify factors that may be hindering your recovery and find a solution.

How can a physiotherapist help?

Your physiotherapist can explain what happens when you have frozen shoulder and advise you on how (much) to use your shoulder. Even though you may be in a lot of pain, it is important to keep moving your shoulder within your limited range of motion. Physiotherapy treatment typically includes:

• Advice on how to maintain a healthy balance between effort and relaxation
• Advice on how to cope with restricted movement during sport, at work, when driving, cycling and walking and when doing (domestic) chores
• Exercises to do at home to support your recovery
• Joint mobilisation and other techniques to relieve shoulder, upper back and/or neck pain and increase your mobility. Exercises and stretches will be appropriate to the stage of frozen shoulder

It is important to note that shoulder pain is not always a sign of frozen shoulder. There are many other shoulder conditions that can cause shoulder pain and restriction. When symptoms first appear, it can be difficult to distinguish the early signs of frozen shoulder from other similar conditions. By asking about your symptoms and conducting a physical examination, the physiotherapist will usually be able to determine the nature of your shoulder problem and whether or not you have frozen shoulder.

Our physiotherapists are available nearby to provide immediate treatment for your symptoms. We have a practice in your company or in the area, so you can start treatment straight away and do not have to spend time travelling. Our physiotherapists are familiar with your workplace. They know a great deal about the workstations, working postures, workloads and strains that the employees within the company have to deal with. They will assess your condition and determine the right treatment and guidance to best meet your needs.