The term Frozen Shoulder (FS) is frequently used in the various consulting rooms of general practitioners, physiotherapists, orthopaedic or trauma surgeons and other healthcare providers. Not in all cases there actually is an FS, but there is confusion with, for example, a postoperative stiff shoulder, osteoarthritis, or an acute bursitis.
It remains difficult to explain to patients (and non-specialised health care providers) the fundamental process that underlie an FS and what the best approach is in each phase. Even more so, because informing, waiting, and giving the natural recovery process time, feels as ‘doing nothing’ for health care providers who are used to ‘doing something’.
This paper describes very clearly what happens at a tissue level in the shoulder during the three phases and provides insight into when it makes sense to exercise (or apply other interventions) and why. The advice is to not read this article on the most detailed level, but to use the broad outlines and advice to inform patients (and referring physicians) better. For shoulder physiotherapists, however, this is a wonderful paper that really dives deep on the tissue level.
This paper, in combination with the Dutch practice guideline Frozen Shoulder, provides a very complete image of the background and therapeutic possibilities:
- The freezing (inflammation) phase takes 4 to 9 months and is characterised by a lot of pain and an increasingly limited range of motion. Therapy is aimed at informing, moving within the pain threshold, relaxation, and maintaining fitness. A corticosteroid injection may be effective in an early stage.
- The frozen (stiffness) phase also takes 4 to 9 months. Limitation in range of motion remains stable, and reactivity and pain are slowly reducing. Gradually, more exercises towards the end positions of the joint can be performed.
- The thawing phase takes 4 to 12 months, depending on therapy compliance. Pain is gone and range of motion slowly comes back. It is allowed to exercise intensively.