Understanding the shoulder: Capsulitis

You might have heard about the term frozen shoulder, also known as adhesive capsulitis or shoulder capsulopathy. This article will try to summarise what it is, present the population at risk, describe the signs and symptoms and suggest ways in which physiotherapy can help!

What is it?  

The shoulder has a capsule that surrounds the joint. For reasons that are still unclear, the capsule can stiffen, thicken and tighten. As the name suggests, adhesive capsulitis is a condition in which the capsule of the shoulder joint retracts and limits the movement available at the shoulder and can often be painful when left untreated. 

Who could have it?  

As far as science is concerned, frozen shoulder can be;  

  • Idiopathic (arise for no particular reason), often seen more in women (70% of cases) aged between 35 and 65 years.  
  • Due to immobilisation of the shoulder for a long time by injury, surgery, or illness. 
  • Associated but not directly related to conditions such as diabetes mellitus, hypothyroidism, cardiopulmonary disease, CVA, Parkinson’s disease. 
  • The continuation of untreated injuries such as rotator cuff pathologies, biceps tendinopathy, calcific tendinopathy, AC joint arthritis.   


What does it look like ?  

It might be painful or difficult to do activities at the end of range like taking a mug off an overhead shelf, brushing your hair, putting on clothes, etc. The common variable between all these activities is the stiffness and discomfort felt. It is characteristic of the condition to also have pain that refers lower in the arm. 

Frozen shoulder can last from months to even 2 years when left untreated. There are 3 known overlapping phases in which frozen shoulder can present itself. 

  • The freezing/acte phase: can last from 2 to 9 months. Movements are mostly limited by pain and it can even be felt at rest. It is often very overtaking and affects the quality of sleep.
  • The frozen phase: can occur around 4 months and last until 12 months. It is when the pain starts to subside, especially at rest. Nonetheless, pain will still be felt at the end of the range and the shoulder remains severely limited.  
  • Thawing phase: can last from 5 to 24 months. It is the progressive improvement in range and the decreased pain. This is where the individual progressively returns to normal activities and functioning. 

How can physiotherapy help?  

Fortunately, the shoulder can usually be “unfrozen”, though full recovery takes time, if left untreated! If you think you have a frozen shoulder or are developing one, the best way to manage that is to visit your physiotherapist and to have it assessed. They will be able to diagnose and guide you through the recovery, give you thorough treatments, prescribe the most appropriate exercises for your stage of healing, guide you in the quantification of the exercises, and help you return to participate in your activities!  

If you are already being treated for a frozen shoulder, remember that recovery can be a slow process and that you need to give treatment time to work. You will soon be able to gain back your ability to do everyday tasks, such as dress and bathe, or even scratch your back!