The Shoulder Joint
The shoulder is designed to have a large amount of movement so that we can use our arms and hands in a wide variety of positions. Some movement occurs between the shoulder blade and chest wall. However, most shoulder movements are at the ball and socket joint. The ball at the top of the arm bone (humerus) fits into the shallow socket (glenoid) which is part of your shoulder blade (scapula). There is a loose bag (capsule) which surrounds the joint. This is supported by ligaments and muscles, which collectively provide movement and stability of the shoulder joint.
Understanding Frozen Shoulder
Frozen shoulder is a condition where the shoulder joint becomes stiff and painful, often developing gradually and without an obvious reason. The capsule, a loose sleeve of tissue that surrounds the shoulder joint, becomes inflamed and appears to tighten or shrink. This tightening, along with the pain, limits movement and can greatly affect the shoulder’s function. Primary Frozen Shoulder, occurs without a clear cause but is more common in people with conditions like diabetes, thyroid disorders, high cholesterol, cardiovascular disease, Dupuytren’s contracture, or a past frozen shoulder on the other side. Secondary Frozen Shoulder, develops after an external factor, such as injury, immobilisation, shoulder surgery, other shoulder conditions like rotator cuff injuries, or weakness from events like stroke. About 15% of cases follow a relatively minor shoulder injury.
What to Expect
Pain predominant phase
Duration: 2 to 9 months
Pain develops gradually, often felt on the outer upper arm and sometimes radiating toward the elbow, becoming constant, movement-related, and disruptive to sleep. Pain dominates this stage as shoulder movement starts to decline, and it may last longer in people with diabetes.
Treatment Focus: The main goals are to manage pain and prevent further stiffness, using pain-relief or anti-inflammatory medication, heat or cold packs, and sometimes a joint injection if appropriate. Physiotherapy focuses on gentle mobility exercises, and using pillows to support the arm at night can improve comfort and sleep.
Stiffness predominant phase
Duration: 4 to 12 months
As pain gradually eases, stiffness becomes the main issue, especially with rotational movements like reaching behind your back or head. The shoulder remains tight even when assisted by the other hand, as the restriction comes from the ball-and-socket joint.
Treatment Focus: During this phase, physiotherapy is central to treatment, focusing on exercises to restore movement in the ball-and-socket joint. Your physiotherapist may use gentle joint mobilisations, and a hydrodistension procedure may be considered to support progress.
Recovery phase
Duration: 12 to 42 months
In the final stage, both pain and stiffness gradually improve, and you begin to regain more natural use of your arm. Some discomfort may still be felt at the end of movements until full recovery occurs.
Treatment Focus: The entire course of frozen shoulder can vary widely, from around 12 to 60 months. Recovery time often depends on how consistently you perform your exercises and how well your shoulder tolerates movement during rehabilitation.
Diagnosing Frozen Shoulder
Frozen shoulder is primarily a clinical diagnosis, based on your medical history and the typical pattern of gradually increasing pain followed by stiffness. Your clinician will ask how your symptoms began, whether you’ve had any recent injuries or surgeries, and whether you have any health conditions linked to frozen shoulder., Physical examination: Reduced active movement (lifting your arm yourself) AND reduced passive movement (when your clinician moves your arm for you). This combined restriction helps distinguish frozen shoulder from other shoulder conditions., Imaging: Imaging isn’t always required for frozen shoulder, but it may be used to help rule out other causes of shoulder pain or stiffness and to check for problems such as arthritis or rotator cuff injuries.
- Ultrasound Assesses the soft tissues around the shoulder and is useful for detecting issues like rotator cuff problems or bursitis.
- X-Ray Provides a clear view of the shoulder bones and helps rule out arthritis, fractures, or other structural changes, though it cannot diagnose frozen shoulder itself.
- MRI Offers detailed images of both bones and soft tissues, and can show signs of frozen shoulder. It is mainly used when another shoulder condition is suspected or symptoms are unclear.
Treatment Options
Treatment focuses on reducing pain, improving movement, and supporting the natural recovery of the shoulder. Most people get better over time, and the right combination of treatments can help speed progress and ease symptoms.
- Pain relief and anti-inflammatories Simple painkillers or anti-inflammatory medication can help reduce discomfort, especially in the early painful stage, and make it easier to participate in physiotherapy.
- Physiotherapy Physiotherapy is the main treatment, using targeted exercises and gentle joint techniques to improve movement as the shoulder recovers.
- Ultrasound-guided treatments Procedures like hydrodistension use ultrasound guidance to accurately stretch the tight joint capsule, often helping reduce pain and improve mobility.
- Surgical options If symptoms remain severe despite other treatments, options such as manipulation under anaesthesia or arthroscopic capsular release can help restore movement by releasing tight areas of the joint capsule.