Frozen shoulder is a condition involving considerable pain and loss of movement in the shoulder joint. Historically, this has been a difficult condition to treat due to a lack of evidence showing the best course of treatment. Left alone, the natural history of frozen shoulder generally takes 12-42 months with the average being 30 months, although the condition is somewhat self-limiting, it is not uncommon for patients to have ongoing limitation of shoulder movement. The standard approach for managing frozen shoulder has been to let the condition run its course; however it is understandable that many patients would rather have the condition resolve in less than 30 months or know the best options for treatment if they are experiencing strong and bothersome pain.
Jeremy Lewis*, a leading expert in shoulder research, published an article in 2015 reviewing evidence for the cause, diagnosis and treatment of frozen shoulder. Lewis explains there is still no known cause for frozen shoulder however there is evidence to show that diabetes, family history, hyperthyroidism, genetic predisposition and ethnicity are risk factors. There is no gold standard for diagnosis however it is generally diagnosed when passive and active ROM are equally limited in all movement directions and plain radiographs are normal. In the article Lewis supports the use of physiotherapy and shoulder joint injections to speed up the natural history of frozen shoulder and get people back to full shoulder function at lot sooner.
Rather than using the traditional three to four phases of frozen shoulder, it may be more beneficial to consider it being in two stages, the first of which is when pain is more prominent than stiffness and the second is when stiffness is more prominent than pain. This simplifies the management of frozen shoulder depending on the patients’ main symptom.
Evidence based management of the first stage involves:
Management of the second stage involves:
At Central Bassendean Physiotherapy we have been using the above management guidelines for our patients’ with frozen shoulder and have noticed significant improvements in outcomes and this can reduce the time it takes for recovery to much less than the average 30 months.
*Lewis J. Frozen Shoulder Contracture Syndrome – Aetiology, diagnosis and management. Manual Therapy. 2015;20:2-9