Knowing how to treat a frozen shoulder first depends on making the correct diagnosis. The familiarity of the term can often lead to over diagnosis. Frozen shoulder is not treated the same as other types of shoulder pain by a physiotherapist, so what sets it apart?

The Pain

The nature of frozen shoulder pain is different for every patient. It’s commonly a developing pain (sometimes described as gnawing or aching), which is always there and worsens with reaching or stretching movements – such as putting on a coat. The pain is often described as much worse at night with some relief using anti-inflammatory medication. This is due to the inflammatory nature of the condition.

Shoulder Stiffness

This is where frozen shoulder takes it’s name and it’s possibly the most important feature of the frozen shoulder when making the diagnosis. If the shoulder is progressively becoming more limited in its range of motion it could well be a frozen shoulder. The role of the physiotherapist is to interpret the type of movement restriction to see if this is consistent with the pattern of frozen shoulder. But essentially, you will notice a loss of elevation, external rotation (taking the hand out to the side while keeping your elbow against your side) and the ability to reach your hand behind your back – reaching for your bra strap for example.

The Person

There are a number of factors which make the diagnosis more or less likely; age, gender, medical history and general fitness all have a role to play in building up the picture. For example women are more commonly affected, as are those with a history of diabetes. There are a lot of features related to the condition that are still under investigation by researchers, but physiotherapists are trained to recognise clusters of features which can help to make the diagnosis.

Treatment

The first line of treatment for a frozen shoulder is appropriate pain relief via the GP or pharmacist. This is a very painful condition and having enough pain relief to allow you to sleep and start exercising early can be crucial to a better long term outcome. The next stage is physiotherapy. Physio is dependent upon the level of pain control. I often say to patients you can’t bully a frozen shoulder better with hard stretching in the early stages. The skill is to find the movements you can manage and gradually increase them with physio exercises. Sometimes hands on techniques to give relief from the associated muscle aches and pains can be useful. For example, it’s common to get associated neck pain which may respond to hands on treatment. But the core evidence based treatment is graded and proportionate physio exercises and this shouldn’t be distracted from.

Failure to get the shoulder moving may result in more limited function and stiffness in the later stages when pain has died down.

Injections

Your physiotherapist can give you advice about the need for a steroid injection. There is very good evidence that these can be effective especially in the early phases of the condition. They are less effective at later stages but this must be considered on an individual basis. There is also a injection procedure know as hydrodilatation which involves pressure and steroid under imaging guidance. Not everyone can be treated with steroids so other pain relief options can be considered through discussion with your physio or doctor.

Surgery

Thankfully few cases of frozen shoulder get to this stage if managed well in the early phases. However there are options such a the capsular release procedure that help to get a frozen shoulder moving again and restore function. This is usually a last resort when intensive physiotherapy and strengthening have failed to return a functional range of motion.

I hope you have found this article useful. Please remember that this is not a substitute for a proper medical assessment and individual care advice. If you suspect you have a frozen shoulder please report to your GP or you can book in for a physiotherapy assessment here at our clinic in Crosby Leisure Centre.

Ben Watkins BSc Hons MCSP HCPC

Chartered Physiotherapist – Blundellsands and Crosby Physio

Ben worked as an NHS clinical specialist in shoulders in Yeovil District General Hospital before moving into private practice. He also has a special interest in treating;

• Rotator Cuff Tears
• Shoulder Tendinopathy/Tendonitis
• Shoulder Instability (Dislocations)
• Shoulder Arthritis and Joint Problems
• Nerve Injury
• Chronic Shoulder Pain
• Sporting Shoulder Complaints

Call Now

The use of ice is something that I’m often asked about in the clinic. While there is controversy around what ice actually does to the bodies inflammatory process, it is clear to me that its use for temporary pain relief is safe and effective for a great many people. I think one of its most useful side effects can be to help reduce the use of pain killers.

There are a great many ways to apply ice to any injury, from the bag of frozen peas to very expensive cryotherapy machines. I wanted to use this quick post to share a product that I think is excellent for it simplicity and ease of application.

The Ice-it-Away!

The ICE-it-away was developed by Claire Robertson who is a physio specialists in the treatment of knee pain. You can purchase an ICE-it-away directly from her website for £19.99 via the button below.

Please note that this is not something I sell here at the clinic or have any investments in. I own one for my own personal use and I am confident to recommend it to my patients, often getting great feedback when I do.

Please note this blog does not constitute medical advice on how and when to use ice safely. For more information please read product instructions in full or to discuss your own case please book in for a consultation.

Thanks for reading!