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Frozen Shoulder - an Evidence Informed Overview

Adhesive capsulitis aka 'Frozen Shoulder' is a medical condition caused by the capsule surrounding the shoulder joint becoming inflamed, thickened, contracted and painful (Hsu et al., 2011). Frozen shoulder can make everyday activities that require the use of the shoulder painfully limited and cause disturbances in sleep and overall well-being. 

About 2-5% of the population will develop a frozen shoulder, with the condition being more common in those around the age of 50 (Ben-Aire et al., 2020) and those with diabetes (Zreik et al.,2016). Here at the clinic, we treat many clients with frozen shoulder each year. 

shutterstock 1016146831According to Maund et al. (2012), a frozen shoulder may resolve itself within 1-3 years without treatment. From my clinical experience, supported by a systematic review by Wong et al. (2017), complete resolution of a frozen shoulder is unlikely to occur without treatment. According to Zhang et al. (2016), current treatment methods may include the use of medication, physiotherapy, corticosteroid injections and other forms of conservative management. I have also found that whereas a typical frozen shoulder may take at least a year to resolve without treatment, with specific physiotherapy treatment, which includes medical acupuncture and graded exercises, resolution usually occurs within 3-6 months. Studies support my clinical approach by Son et al. (2005) and Lo et al. (2020), showing that adding electroacupuncture combined with rehabilitation exercises effectively reduces pain and improves shoulder movement. 

Some more facts about frozen shoulder:

Painful overactivity of the upper trapezius muscle, which links the neck to the shoulder, may reduce movement in those with frozen Shoulder (Lin et al., 2005). Clinically I have found it essential to target the upper trapezius muscle and deactivate sensitive myofascial trigger points, which may have developed within this muscle. 

In addition to limited shoulder outward rotation and elevation (arm raising) movements, Ide (2016) has confirmed that shoulder internal rotation movements are also usually limited in those with frozen shoulder. Limited internal rotation makes it difficult to reach behind your back, do up a bra, and sometimes go to the bathroom.

Frozen shoulder is often associated with weakness of the shoulder muscles, including the supporting rotator cuff muscles Sokk et al., (2013). The good news is that muscle strength can be effectively restored with the correct exercises done the right way, at the right time.

If you suspect you are struggling with a frozen shoulder, my advice would be to have your shoulder assessed by an experienced chartered physiotherapist who will make a diagnosis and plan a course of treatment.

Typically, a course of treatment for frozen shoulder requires approximately six weekly sessions, to begin with, followed by a review every 2-3 weeks after that until full resolution occurs.

If you have any questions or would like some further information about our treatment approach, please email us at This email address is being protected from spambots. You need JavaScript enabled to view it..

In good health  

Simon Coghlan MSc, BSc Physio, DipMedAc
Chartered Physiotherapist

References

Ben-Arie, E., Kao, P. Y., Lee, Y. C., Ho, W. C., Chou, L. W., & Liu, H. P. (2020). The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2020. https://doi.org/10.1155/2020/9790470

Hsu, J. E., Anakwenze, O. A., Warrender, W. J., & Abboud, J. A. (2011). Current review of adhesive capsulitis. Journal of shoulder and elbow surgery20(3), 502-514.

Ide, J. (2016). Frozen Shoulder. In Advances in Shoulder Surgery. https://doi.org/10.1007/978-4-431-55988-7_13

Lin, J. J., Wu, Y. T., Wang, S. F., & Chen, S. Y. (2005). Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clinical Rheumatology, 24(6). https://doi.org/10.1007/s10067-005-1105-x

Lo, M-Y., Wu, C-H., Luh, J-J.,Wang, T-G.,Fu, L-C.,Lin, J-G., Lai, J-S. (2020). The effect of electroacupuncture merged with rehabilitation for frozen shoulder syndrome: A single-blind randomized sham-acupuncture controlled study. Journal of the Formosan Medical Association, 119(1), 81-88.

Maund, E., Craig, D., Suekarran, S., Neilson, A. R., Wright, K., Brealey, S., Dennis, L., Goodchild, L., Hanchard, N., Rangan, A., Richardson, G., Robertson, J., & McDaid, C. (2012). Management of Frozen shoulder: A systematic review and cost-effectiveness analysis. In Health Technology Assessment (Vol. 16, Issue 11). https://doi.org/10.3310/hta16110

Sokk, J., Gapeyeva, H., Ereline, J., Merila, M., & Pääsuke, M. (2013). Shoulder muscle function in frozen shoulder syndrome patients following manipulation under anaesthesia: A 6-month follow-up study. Orthopaedics and Traumatology: Surgery and Research, 99(6). https://doi.org/10.1016/j.otsr.2013.04.008

Son, C-H, Lim, H-J, Lee, W-H, Jeong, B-J, Sung, S-M, Moon, S-I (2005) The effects of Electroacupuncture Therapy with the shoulder Pain of Frozen Shoulder Patients Analyzed by Visual Analogue Scale. Journal of Acupuncture Research. Vol 22(4), 27-34.

Wong, C. K., Levine, W. N., Deo, K., Kesting, R. S., Mercer, E. A., Schram, G. A., & Strang, B. L. (2017). Natural history of frozen shoulder: fact or fiction? A systematic review. In Physiotherapy (United Kingdom) (Vol. 103, Issue 1). https://doi.org/10.1016/j.physio.2016.05.009

Zhang, H., Sun, J., Wang, C., Yu, C., Wang, W., Zhang, M., Lao, L., Yi, M., & Wan, Y. (2016). Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain. Acupuncture in Medicine, 34(3). https://doi.org/10.1136/acupmed-2015-010947

Zreik, N. H., Malik, R. A., & Charalambous, C. P. (2016). Adhesive capsulitis of the shoulder and diabetes: A meta-analysis of prevalence. In Muscles, Ligaments and Tendons Journal (Vol. 6, Issue 1). https://doi.org/10.11138/mltj/2016.6.1.026

 

 

 

 

 

 

 

 

 

 

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