Osteopathic Journals and Research by Darren Chandler


Frozen shoulder (Adhesive capsulitis)

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  • What is frozen shoulder
  • Who gets frozen shoulder
  • The treatment of frozen shoulder

What is frozen shoulder

The joint capsule of the shoulder encases and forms an outer ‘skin’ of the shoulder joint. A frozen shoulder occurs when scar tissue forms inside the shoulder capsule causing it to thicken, swell and tighten(1). On top of this patients’ experience tightness of the muscles and other soft tissues giving pain and restricted movement(2).

 Frozen shoulder has three stages(1). The average length of these stages without treatment is 30 months(2):

  • Stage one: the shoulder aches becoming painful when reaching out for things or when you lie on the bad side. This can last two to nine months.
  • Stage two: the shoulder becomes increasingly stiff. The pain may not get worse and could even start to decrease. The muscles around the shoulder start to waste as they're not being used. This can last for four to twelve months.
  • Stage three: slowly you’ll regain some movement in your shoulder. The pain starts to fade, although it may temporary return as the stiffness eases.

The most common position that patients find limited is the position your arm goes into when you put it up to wave (flexion/abduction/external rotation)(2).

 Who gets frozen shoulder

Up to 1 in 20 people in the UK may be affected by frozen shoulder.

You are more at risk from developing a frozen shoulder if you have(1):

  • Previous shoulder injury or shoulder surgery
  • Inactivity of the shoulder
  • Diabetes (type 1 or 2)
  • Dupuytren's contracture 
  • Heart disease and stroke
  • Lung disease
  • Hyper- or hypothyroidism
  • Breast cancer (or shoulder cancer(2))

Near enough all the frozen shoulders we see in the clinic are due to another shoulder injury or immobility of the shoulder for whatever reason. However it is good practice to be examined by your GP prior to any treatment.

The treatment of frozen shoulder

Conservative (non-invasive) treatment options include(1):

  • Antiinflammatories and pain killers
  • Corticosteroid injection
  • Stretch, massage and home exercises

Surgical treatment options include(1):

  • Manipulation under anaesthetic: the shoulder is ‘numbed’ with an anaesthetic and manipulated to break up adhesions.
  • Arthroscopic capsular release: a special probe is inserted in the shoulder that emits a high-frequency radio wave which is used to cut out the thickened parts of the shoulder capsule.
  • Arthrographic distension (hydrodilation): the shoulder joint is ‘inflated’ with a steroid and saline solution to stretch the shoulder joint.

Research grading the effectiveness of different treatment options for frozen shoulder has found manual therapy to mobilise (move) the shoulder and home exercises to be effective in reducing pain and increasing movement(3). These can be performed by your osteopath who can also use massage and manipulation to relieve any other associated problems that develop along side your frozen shoulder.


(1) http://www.nhs.uk/Conditions/Frozen-shoulder/Pages/Introduction.aspx

(2) Adhesive Capsulitis: use the evidence to integrate your interventions (2010). Page P Labbe A

(3) Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study (2009). Jewell D. V., Riddle D. L., Thacker L. R. 

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