Physio: Is it ‘frozen shoulder’ or just stiff?

Connective tissue happens if a person has had a shoulder injury and did not move the shoulder for a long period after the injury.

Here at Sun City Physiotherapy, we often see patients with shoulder injuries who are worried that they have developed “frozen shoulder.”

Adhesive capsulitis, commonly known as frozen shoulder, is a condition where the connective tissue surrounding the shoulder becomes thick and tight. It can be painful in certain stages of development and is associated with a loss of movement in a particular pattern.

Unfortunately, we do not know what causes adhesive capsulitis. The risk of developing this condition increases if you have had trauma to the shoulder, shoulder or chest surgery, or prolonged immobilization, however others develop it spontaneously. It is more common among women, people aged 40-60 years old, and diabetics.

There are three stages of adhesive capsulitis; the freezing stage, frozen stage and thawing stage, and it may take a while for one’s body to move through these phases.

The good news, however, is that adhesive capsulitis is rare and most patients that come to see us with decreased shoulder range do not actually have this condition.

Many patients come to physio after an acute muscular shoulder injury, such as a rotator cuff injury, when the movement of the shoulder is limited due to pain or muscular tone. Although the range of motion is limited when the patient tries to move his or her own arm, it is not limited when the Physiotherapist moves it passively. This is a good sign, in that the stiffening process has not begun and the patient can prevent stiffness by keeping the arm mobile while the soft tissue is healing.

Sometimes we see patients who have had a longstanding injury resulting in stiffness of their shoulder in a pattern that is different from the pattern we see with adhesive capsulitis. In this situation, stiffness in parts of the connective tissue surrounding the shoulder joint has occurred without a thickening of the entire capsule. This often happens if a person has had a shoulder injury and did not move the shoulder for a long period after the injury. It can also occur after shoulder surgery. Again, this is a good sign in that physiotherapy and exercises can help to loosen the shoulder and restore range of motion.

One of the best ways to prevent frozen shoulder from developing is to wear your jacket when you are outside this winter. Just kidding. The actual best technique to prevent the shoulder from becoming stiff is to keep it mobile after an injury. To do this you can place the hand of the injured arm on top of a broom stick and use the other arm to slowly lift the broomstick as high as you can without causing pain in the injured arm. Repeat this 10 times in a row throughout the day trying to bring your arm a little bit higher each time without causing pain. If you have just had shoulder surgery make sure the surgeon approves this exercise before performing it.

You can also see your local physiotherapist to help diagnose what is causing your decreased motion and how to properly manage it. If you have already been diagnosed with adhesive capsulitis your physiotherapist can assess in which stage of healing you are, and what exercises and therapy will be the best for you during that period of healing.  If adhesive capsulitis is not present, but your shoulder is stiff, mobilizations your physiotherapist will perform can have a substantial impact on improving your range of motion and keeping your shoulder “unfrozen” this winter.