Adhesive capsulitis, also known as ‘Frozen shoulder’ or ‘stiff shoulder’ is a painful and extremely limiting condition that results in an inability to get full active AND passive range of motion/movement (AROM and PROM) at the shoulder joint. It’s most commonly seen in an inability to abduct (lift the arm up from the side of the body) and externally rotate.
The actions of throwing a ball, giving a high-five, scratching your back, getting dressed and overhead activities can become difficult and limiting for those with adhesive capsulitis.
Source: Musculoskeletal Key
What is Adhesive Capsulitis?
There is still discrepancy as to what the pathology of adhesive capsulitis is, however, adhesive capsulitis has been seen to usually occur as a combination of synovial inflammation/synovitis and capsular fibrosis/contracture. Since the shoulder joint is a synovial joint, it is lined by a synovium (synovial membrane and synovial fluid which works to lubricate the joint). Synovitis occurs when the synovium thickens and becomes engorged with fluid, causing inflammation. This can then make the joint less movable and hence stiff.
Source: Prahran Sports Medicine
Additionally, capsular fibrosis, which is essentially a stiffening of the ligaments surrounding the shoulder joint can play a role in adhesive capsulitis.
Adhesive capsulitis has a long course and can last around 18-24 months of pain that progresses to stiffness and eventually range of motion improvements.
The Cause/Risk Factors
There are many causes for adhesive capsulitis and it can be both spontaneous without preceding cause or it can be a result of a disease or event. Risk factors may include diabetes, having a low BMI or being underweight, tendinopathies of the rotator cuff and biceps muscles as well as having previous rotator cuff surgery or pathologies that result in an immobilised shoulder for a period of time.
How to Know if you Might Have Adhesive Capsulitis
- Type of pain: the pain is dull and aching but severe and sharp with rapid/reactive movements
- Timing of pain: If you find that you have constant night pain because of the shoulder, pain with quick movements, pain when lying on the shoulder or if the pain is easily aggravated by simple movements
- Range of movement: if you can’t move your shoulder in all the directions and as much as the other shoulder
Treatment
Particularly when trying to avoid adhesive capsulitis after rotator cuff surgery or injury, it’s important to keep the joint moving and mobilised. Since the area is still sensitive after these experiences, it’s a good idea to have a myotherapist mobilising the joint. The myotherapist might use manual mobilising techniques to increase the ROM of the joint whilst keeping the healing the process undisturbed.
Home passive stretching can also work to increase ROM and assisted active ROM exercises. These also can be guided by a myotherapist to ensure stretching of the correct areas is achieved.
A last-resort treatment can include surgery, however it is rarely required and only necessary in severe cases where myotherapy or therapy cannot improve the condition.
Frozen shoulder treatment in Melbourne
Frozen shoulder responds best to consistent, graded work rather than occasional heavy treatment. At our South Melbourne clinic the approach depends on which stage you are in. In the painful freezing stage the priority is settling irritation and keeping whatever range you still have. In the stiff frozen stage the focus shifts to restoring movement through joint mobilisation and soft tissue work through the surrounding muscles, which almost always tighten in compensation.
Treatment typically combines hands-on mobilisation with remedial massage through the shoulder, upper back and neck, plus a home program you can keep up between appointments. Because the condition runs over many months, what you do on your own matters as much as what happens in the room.
How long does frozen shoulder take to recover?
Most cases run 18 to 24 months in total, moving through three stages: freezing, where pain dominates; frozen, where pain eases but stiffness takes over; and thawing, where range gradually returns. That timeline is frustrating but it is also the normal course of the condition rather than a sign treatment is failing. Treatment aims to keep you functional through it and to protect the range you have, rather than to shortcut the biology.
When should you get a stiff shoulder checked?
Get it assessed if shoulder movement has been restricted for more than a few weeks, if night pain is disturbing your sleep, or if you cannot reach behind your back or lift your arm overhead on one side. Early-stage frozen shoulder is often mistaken for a rotator cuff strain, and the treatment for the two is not the same. An assessment sorts out which you are dealing with.
Our South Melbourne clinic is open 7 days, 8am to 8pm. Book an assessment online or contact the team if you are unsure whether this is what you have.