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