4 stages of Frozen Shoulder (Adhesive Capsulosis)

Stiff or Frozen Shoulder (Adhesive Capsulitis) is one of the most common causes of shoulder pain and can be related to:

• Reactions after injury or surgery
• Pain from other conditions such as Arthritis, rotator cuff tear or other injury which affects the movement of your shoulder.
• Immobilisation of your arm such as in a sling, following surgery or a fracture.

Frozen shoulder is most common in patients between the ages of 40-60 years, occurring in women more often than men and if you are diabetic you could be more likely to get frozen shoulder. The connective tissue surrounding the joint of the shoulder becomes inflamed and stiff, creating tight bands called adhesions and results in pain and restricted motion. The symptoms can occur in one shoulder, or on occasions both shoulders with the patient unable to move their shoulder, either on their own, or aided by someone else. Frozen shoulder typically develops in four stages. Treatment with Physiotherapy can help speed up its resolution and restore function.

Stage 1 - 'Pre-Freezing'

If you have received a diagnosis of adhesive capsulitis, you have probably been experiencing the symptoms for some time. The shoulder is painful during the day and night, worse when you attempt to move the shoulder but can ache even when it is not used. Movement will have decreased by small amounts and you will find you have reduced the use of the shoulder due to the pain. Pain is most noticeable when you lift your arm away from your body, with movement loss more noticeable when you raise your arms or reach behind your back. 

Treatment in the clinic will consist of a combination of stretching and manual therapy techniques to reduce your pain and increase your range of motion. This will be followed up with advice and exercises to maintain and progress things at home

Stage 2 - 'Freezing'

The freezing stage is typically when the symptoms have been present for between three and nine months, night time pain will have increased with a progressive loss of shoulder movement, Range of movement continues to be limited by pain and stiffness.

Similar to stage one, your physio will advise a home exercise program to help with pain and movement. In the clinic will consist of a combination of stretching and manual therapy techniques to increase your range of motion.

Stage 3 - 'Frozen'

At this stage, there are persistent symptoms between Nine and Fourteen months with range of motion dramatically reduced. The earlier parts of this stage see a substantial amount of pain with pain decreasing towards the end of the frozen stage. The pain then may only occur when the shoulder is moved to the end of the available range of motion.

Focus is now on the return of motion, more aggressive stretching and manual therapy techniques and strengthening exercises, this will also be reflected by the home exercise program.

Stage 4 - 'Thawing'

Typically, symptoms between twelve and fifteen months, the pain has decreased especially pain during the night. Range of movement is still limited but is returning to that seen prior to onset.

This is where the physio will be encouraging the return to normal movements, continuing the stretching, strength training and manual therapy techniques.