Frozen shoulder (adhesive capsulitis)

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What is it about ?

A frozen shoulder is called adhesive capsulitis or adhesive capsulitis in medical parlance. In English, we speak of ‘frozen shoulder’. The term ‘adhesive capsulitis’ indicates that there may be adhesions in the sleeve that surrounds the shoulder joint (joint capsule).

The shoulder is painful and stiff.

The joint capsule is thicker and inflamed. Tissues can heal, stick together, we speak of adhesions. The muscles of the shoulder may be strained.

The precise cause of this condition is not yet well known. Often it is caused by a combination of several factors.

  • The condition can develop after a shoulder injury or surgery, when you have not been able to move your shoulder for a long time.
  • The affection can develop without knowing why, without apparent cause. This is called an ‘idiopathic’ frozen shoulder.

Sometimes a frozen shoulder can heal on its own, but it can take a long time (sometimes 1 to 2 years).

It is important to move as much as possible. An exercise program supervised by a physical therapist can certainly help in a full recovery.

Evolution

A “frozen shoulder” goes through different phases.

  • The inflammatory phase:
    • the shoulder is inflamed and painful;
    • the pain is stronger at night;
    • moving your shoulder becomes more difficult;
    • if the doctor examines your shoulder and moves your arm, he sees that all movements are possible;
    • this phase can last 2 months.
  • The phase of stiffening, blocking:
    • your shoulder becomes more and more stiff, it becomes like ‘jelly’;
    • stiffness is the biggest problem;
    • the pain, sometimes stronger at night, gradually decreases;
    • this phase lasts from 2 to 6 months.
  • The recovery phase:
    • this is the “thaw” phase;
    • your shoulder becomes more and more mobile;
    • this phase can last 1 to 2 years.

At whom and how often do we meet it?

Frozen shoulder is very common. It affects 2 to 5 people out of 100.

She touches :

People who have had a trauma or shoulder operation with prolonged shoulder immobilization are more at risk of developing a frozen shoulder.

How to recognize a frozen shoulder?

Your shoulder is sore and stiff:

  • your shoulder hurts more and more;
  • you may be in pain even when you are not moving your shoulder;
  • you may have pain at night, especially at first, especially if you are lying on your shoulder;
  • it hurts if you move your shoulder suddenly;
  • your shoulder becomes stiff, you move it harder and harder.

How does your doctor diagnose frozen shoulder?

Your doctor will usually diagnose frozen shoulder by simply asking you a few questions and examining your shoulder.

Sometimes he may order additional exams like, for example, an x-ray and an ultrasound to see if there is anything else.

What can you do ?

  • At first, in the first phase (inflammatory phase), you can apply cold compresses to the shoulder.
  • Either way, it helps to keep moving and carry on with your daily activities as much as possible, within the limits of pain. However, avoid movements and loads that make the pain worse.
  • Processing can take a long time. A good relationship of trust with your doctor and / or your physiotherapist is important. You will regain all your mobility, or almost. If you have diabetes, the end result may be a little worse.

What can your doctor do?

Your doctor will guide you as you progress. Depending on the stage, your pain and your stiffness, he may suggest certain treatments.

The treatment of a frozen shoulder is usually done in collaboration with a physiotherapist. The opinion of a specialist is sometimes necessary.

The possible treatments are:

  • a painkiller:
    • paracetamol ;
    • a non-steroidal anti-inflammatory drug, for example, ibuprofen or naproxen;
    • a mild opioid.
  • an injection into the shoulder joint (intra-articular infiltration) of cortisone to decrease inflammation and physiological saline to stretch the capsule (capsular distension). This injection is especially effective during the first stage (the inflammatory phase);
  • physiotherapy (to see further);
  • an operation :
    • arthrolysis: the surgeon looks with a small camera in your shoulder (arthroscopy) and detaches the adhesions there.
    • manipulations under general anesthesia: the surgeon manipulates your shoulder to free it.

What can you do with your physiotherapist?

Your physiotherapist plays a very important role in the follow-up and treatment of a frozen shoulder. This is often a lengthy treatment. Exercise therapy plays a central role in managing pain and regaining mobility.

Your physiotherapist can:

  • give you information about the condition and treatments and listen to your complaints;
  • examine your shoulder and thus assess:
    • the stage of the affection;
    • the severity of the condition, depending on the pain, stiffness and what you are doing
    • the impact of affection on your daily life.
  • give you advice on how to best manage the affection in everyday life. For example, learning to manage certain functional limitations;
  • suggest exercises:
    • adapted to your situation and to the stage of the affection, you can therefore practice them in complete safety;
    • movements, stretching, strength exercises. Strength exercises are important, even if they are sometimes uncomfortable;
    • some exercises are to be done at home;

During the sessions, your physiotherapist can:

  • massage the shoulder and neck muscles if it helps you relax;
  • move your shoulder and apply other specific techniques to
    • reduce shoulder, upper back and neck pain,
    • increase mobility;
  • check your progress using measuring instruments.

    Your physiotherapist works with your doctor (general practitioner)

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