The primary means of diagnosing frozen shoulder is a physical examination. Your shoulder is a ball-and-socket joint made up of three bones. Your arm bone known as your humerus, your shoulder blade known as your scapula, and your collarbone known as your clavicle or collar bone. The head of the arm bone fits into a shallow socket in your shoulder blade. Connective tissue, called the shoulder capsule, surrounds the joint. Furthermore, you have a number of ligaments and rotator cuff muscles that cover the bones of the shoulder.

During the exam, your health practitioner may test your active movement (movement without assistance) by asking you to raise and lower your arm to the front, sides and back of your body. Our practitioners may also test your passive movement (movement with assistance) by manually moving your arm and shoulder to determine your range of motion. As well, he or she may press on parts of your shoulder to see what might cause pain. Loss of both active and passive movement and a pattern of generalized (diffuse) shoulder tightness and pain are strong indicators of frozen shoulder.

Obtaining an X-ray or ultrasound image of your shoulder joint is a good idea. A magnetic resonance image (MRI) scan of the shoulder isn’t necessary to diagnose frozen shoulder, but your practitioner may suggest an MRI scan to exclude other structural shoulder problems.

Frozen shoulder can occur after an injury to your shoulder (such as after surgery or after an arm fracture) or prolonged immobilization (keeping it still) of your shoulder. Individuals who are female gender, older than 49 years, have diabetes mellitus (five times more likely to get frozen shoulder), cervical disc disease, hyperthyroidism, stroke or myocardial infarction, an autoimmune diseases, or trauma (i.e. motor vehicle accidents) are at greater risk of having frozen shoulder.

The shoulder capsule becomes inflamed and stiff. The inflammation/swelling may cause bands of tissue (adhesions) to develop between your joint’s surfaces. Synovial fluid, which helps to keep your joint lubricated and moving smoothly, may decrease. As a result, pain and subsequent loss of movement may occur. In some cases, mobility may decrease so much that performing everyday activities such as combing your hair, brushing your teeth, or reaching for your wallet in your back pocket, is difficult or even impossible.

The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else. Frozen shoulder develops in three stages:

Stage 1 – Freezing
In the freezing stage, you progressively get more and more pain. As the pain worsens, you lose range of motion in your shoulder. Freezing typically lasts from 6 weeks to 9 months.

Stage 2 – Frozen
In the frozen stage, painful symptoms may actually get better during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, activities of daily living (combing hair, brushing teeth, putting on clothes) may be very difficult.

Stage 3 – Thawing
Shoulder motion slowly improves during the “thawing” stage. The complete return to normal or close to normal strength and motion in the shoulder typically takes 6 months to 2 years.

Frozen shoulder is a self-limiting condition which lasts between 12 to 18 months. Patients seeking care usually recover more quickly, thus it is important to seek treatment early rather than later. Conservative treatment options include soft tissue therapy, acupuncture, laser therapy, massage techniques, myofascial release, hydrotherapy, exercise/rehabilitation (codman exercise picture below) and natural anti-inflammatory remedies. These treatment options, all of which are offered at the clinic, can be helpful in managing pain along with improving shoulder function.

Non surgical conventional treatment options include nonsteroidal antiinflammatory medications, oral corticosteroids, and interarticular cortisone injections. It is important to discuss over the counter and prescription medication with your family doctor or pharmacist.

Surgical conventional treatment include manipulation under anesthesia and/or shoulder arthroscopy. Manipulation under anesthesia is a procedure where you are put to sleep. The surgeon will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion. Shoulder arthroscopy involves your surgeon cutting through tight portions of the joint capsule. This is done using instruments inserted through small incisions around your shoulder. It is very important to commence an exercise and rehabilitation program following the surgery. Be sure to discuss these surgical options with your family doctor and specialist.

Chiropractic Options Offered: Dr. Luciano Di Loreto (Chiropractor) and his team of health therapists can help you rehabilitate your muscles after a shoulder fracture via both active exercises as well as passive treatments. Our extensive passive treatments include laser therapy (healing), ultrasound (healing), electrotherapy (pain), hot/cold therapy and soft tissue therapy. Treatments are usually booked two to three times per week. Full recovery varies from individual to individual.