Frozen Shoulder Treatment 101 – How to cure frozen shoulder quickly

Frozen Shoulder (Adhesive Capsulitis) is a condition which can take months to improve. While there are no magic fixes that will cure frozen shoulder quickly, there are some ways you can encourage a faster return to full function and make yourself more comfortable during the healing process.

In this article, we will detail:

• What Frozen Shoulder is and who it affects
• How to diagnose Frozen Shoulder
• Physio for Frozen Shoulder
• Frozen Shoulder exercises to speed up recovery
• Injections for frozen shoulder

Read on for the full run down on this complex condition.

What is Frozen Shoulder?

Frozen shoulder is not a super common condition but it can be one of the most painful and debilitating, especially early on. It is a condition that we still do not fully understand, but we are slowly learning more about it.

What we know at the moment is that it affects women more than men, is common between the ages of 40-65, can affect one or both shoulders (not usually at the same time) and can take a very long time to improve.

Another name it is known as is Adhesive Capsulitis, however this can be misleading as there is no actual adhesions within the shoulder. One thing we don’t quite understand yet is how it develops.

Sometimes there is an event (such as an injury or surgery) that can trigger a severe inflammatory response in the joint which then leads into changes within the cells themselves, resulting in a contracture (or stiffness) of the joint capsule – it becomes frozen.

Other times it can develop due to systemic factors (such as diabetes) or without any known reason at all.

What is Frozen Shoulder pain like?

Initially frozen shoulder shares a lot of similarities with other shoulder pathologies (such as an acute rotator cuff tear, osteoarthritis, calcific tendonitis) which can make it difficult to diagnose early on and as a result it is often over-diagnosed or misdiagnosed (see our post on Chronic Shoulder pain to find out some of the other causes).

This can be a problem as the diagnosis is a key component to getting the right treatment at the right time as it varies depending on the ‘stage’ of frozen shoulder, which we will discuss soon. People with frozen shoulder commonly present with the following symptoms in the early stages:

• Sudden onset of severe pain. This is often constant and a commonly an unbelievable level of pain which is easily aggravated by small movements.
• Loss of movement – can be sudden or gradual. Usually when bringing the arm out from the side or overhead
• Difficulty sleeping due to night pain
• Pain extending from the shoulder down to the elbow and also down into the forearm
• Not many things that can help ease the pain

These symptoms by themselves do not mean it is a frozen shoulder as there are other conditions that have similar symptoms. Rather it is the combination of these symptoms, a reduction in range of motion in particular movements and a clear scan to rule out other conditions which forms the basis of the diagnosis.

Once the diagnosis is made the next step is to work out what stage you are in to see what options you have for treatment. A few classifications of the stages of frozen shoulder exist, however the most useful one for determining treatment is a 2 stage classification. The first stage is where there is more pain rather than stiffness (otherwise known as the freezing stage) and the second stage is when it is stiffer rather than painful (frozen stage).

Treatment for Frozen Shoulder (Phase 1)

Cortisone Injection for Frozen Shoulder

As mentioned treatment options are dependent on what stage you are in. In the first stage (the painful stage) it has been shown that the most beneficial treatment can be a cortisone injection.

This is an injection that is inserted either into the joint and/or into the subacromial bursa with the guidance of an ultrasound. Once it is clear a shoulder is becoming a frozen shoulder then an early referral for an injection has been shown to help with pain (especially night pain) and also with helping to delay some of the stiffness.

The earlier the better with these injections as if left too late their effectiveness may reduce. In addition to an injection it is encouraged to find activities that are not aggravating, even if it is just some simple movements during the day.

It is not helpful trying to get it to do more or work into the pain as it can stir it up for a long time. Some activities may need to be modified as well in order stop aggravating it. This phase will gradually improve, however the length of time can be quite long.

Surgery for Frozen Shoulder

Some people opt for more invasive treatments such as a manipulation under anaesthetic or a surgical capsular release. The manipulation involves being put under a general anaesthetic and the specialist forcing the joint to move and the capsular release involves the specialist performing an arthroscopic surgery to cut the parts of the joint capsule that are affected.

These two approaches have shown to improve function in the short term compared to standard physiotherapy, however long term results after 12 months appear similar.

Physio for Frozen Shoulder

In regards to hands on treatment, there is very little benefit from massage or other manual therapy. If there is it may only be temporary. What can be more helpful is using heat packs to help reduce any other muscle tension that may be present. The main thing you can do for it in this stage is to keep it moving as much as comfort allows.

Treatment for Frozen Shoulder (Phase 2)

Exercises for Frozen Shoulder

Once it moves into the second stage (which isn’t necessarily a clear transition) the focus of treatment changes. In this stage pain is no longer the dominant factor which often means sleeping is better and you can use the arm without the same level of pain. It also means that you can now start to increase the exercises, both general activity as well as specific and targeted exercises to try and improve the range of motion of the shoulder.

Stretching in this stage does not actually necessarily improve the length of the muscles but some people find it helpful to do. The specific exercises that have been shown to help the most are called eccentric exercises, which are exercises where the muscle is working against a resistance as it gets long.

Two examples are:

Fall outs – supported external rotation (Level 1 – 45 Degrees Abduction)

Fall outs – supported external rotation (Level 2 – 90 Degrees Abduction)

Up Pulls – reverse lat pull down

The aim of these exercises are to improve the extensibility of the joint capsule by putting it under load. This works as the joint capsule and rotator cuff muscles blend together, so by engaging the muscles at the same time of stretching it is targeting the most limiting restriction.

How heavy should they be? How often?

The general guidelines for these exercises are to do as heavy as possible where you are able to do about 5 or 6 repetitions with 3-4 sets, completed 2-3x/week and it should be done slowly – about 7-10 seconds per repetition.

This is all dependent on pain and ability in doing it. If it is painful then the exercise should be modified, such as reducing the weight. These exercises do not improve overnight but by being consistent with it and incorporating other general activity as able you are giving the shoulder the best opportunity it has to improve its function.

How long will it take to get better?

In the end everybody with frozen shoulder may have difference experiences. Some people may a have a short (12 months) but intense duration, some people may have a drawn out process.

Some people may respond well to the injections, others may require further intervention. The overall outcome does vary and it is still not clear why some people do better than others.

In order to get the best outcome from their shoulder it is recommended to see a physiotherapist who can help guide you in the process and help you with your individual treatment choices.