Shoulder
Frozen Shoulder - Understanding the Condition and Exploring Treatment Options
At our practice, BodyLab Osteopathy and Physiotherapy | Rehabilitation and Training in Zurich, we regularly see patients with a painful shoulder and severely restricted mobility. Often taking a wait-and-see approach, these patients only consult a doctor after several months, when significant physical limitations have already set in.
In this blog post, we dive into the development and causes of a frozen shoulder (adhesive capsulitis) to educate and inform you—helping you recognize the signs early. We will also explore treatment options and evaluate their effectiveness based on current scientific studies.
What Exactly Is a Frozen Shoulder?
A frozen shoulder, clinically known as adhesive capsulitis, is a painful condition that severely restricts both active and passive shoulder movement, especially in the early stages.
Standard orthopaedic literature describes three distinct phases of the condition:
Phase I: An initial inflammatory phase, characterized by sharp, severe pain—particularly at night.
Phase II: The freezing phase, where stiffness sets in alongside the pain. Over time, everyday tasks like getting dressed or reaching for a seatbelt become highly challenging, often accompanied by sharp, pulling pain in the front of the shoulder.
Phase III: The thawing phase, where normal mobility gradually returns and pain subsides, especially when supported by targeted manual mobilization techniques in physiotherapy.
The Underlying Causes
In most cases, a frozen shoulder is idiopathic, meaning the exact cause remains unknown. However, research indicates that diabetes, shoulder trauma (such as rotator cuff injuries, long biceps tendon issues, or impingement), thyroid disorders, high BMI, and cervical spondylosis significantly increase the risk [1]. Interestingly, occupational or athletic activities do not seem to have an impact. While the role of stress and mental health is discussed in scientific literature, a clear link has not yet been proven. It is also quite common for individuals who experience a frozen shoulder to eventually develop it in the other shoulder as well.
What Happens inside the Body
The exact pathophysiology of a frozen shoulder is still being studied. Research reveals that joint capsule inflammation involves both synovitis and capsular fibrosis. Cytokines and an overactive immune response appear to trigger a subsequent fibrosis of the shoulder joint, driven by increased fibroblast activity.
Braus, Hermann, Braus 1921 148, marked as public domain, details on Wikimedia Commons
How to Recognize the Early Signs
Many patients overlook the initial signs of a frozen shoulder and delay seeing a specialist. This is because we rarely think about the complex, automatic mechanics of our shoulders—we usually focus on where our hands are moving. Early compensatory movements often go unnoticed. This delay allows fibrotic processes to progress, making the recovery journey much longer. If you experience burning or pulling shoulder pain, especially at night, do not wait. Have it assessed by a specialist early on.
The shoulder joint is incredibly complex, mastering the ultimate balance between high mobility and stability. Even minor changes or repetitive strain can lead to joint issues.
Because symptoms vary and diagnosis is complex, it is always best to leave the assessment to a trained professional.
Effective Treatment Options
Several studies show that cortisone injections are highly effective in the short term for reducing pain and inflammation, particularly during the initial phase [4,7]. In our experience, this can be highly beneficial—especially for patients experiencing a second frozen shoulder—but it should always be combined with passive manual therapy!
Laser therapy is highly recommended for quick, early pain relief, although it does not directly improve overall joint function or range of motion [4,7].
Active exercise therapy, passive physical therapy, or osteopathic mobilization are highly effective for improving pain and restoring mobility during phases 2 and 3 [4,5].
Electrotherapy, ultrasound, and heat therapy can offer temporary pain relief, though long-term studies show limited lasting benefits [7].
Acupuncture has not been scientifically proven to be effective for this condition [7].
As a last resort, arthroscopic capsular release (arthrolysis) is a highly effective surgical option. This procedure removes inflamed tissue and frees up the tight joint capsule. However, surgery is considered a final step, typically reserved for cases that show no improvement after months or years of conservative therapy [6,7].
In short, an early diagnosis is your best strategy. A prompt MRI assessment allows for timely intervention, such as a targeted injection to calm the inflammation. Once the acute phase subsides, starting a structured conservative therapy program is key. Active movement and tailored home exercises are essential for a full recovery. Ultimately, the most important factor is consistency. Even with the best care, recovery can take several months or even years.
If you are experiencing similar symptoms, do not push them aside. Reach out to us or consult your doctor today.
Whenever you need us, we are here to support you!
Your BodyLab Team, by your side until your shoulder is fully back in action
Osteopathy and Physiotherapy | Rehabilitation and Training
Zurich Altstetten
References
[1] Case control study of risk factors for frozen shoulder in China.
Li W, Lu N, Xu H, Wang H, Huang J.
Int J Rheum Dis. 2015 Jun;18(5):508-13. doi: 10.1111/1756-185X.12246. Epub 2014 Jan 18.
[2] Primary frozen shoulder: brief review of pathology and imaging abnormalities
Kazuya Tamai, Miwa Akutsu, and Yuichiro Yano.
J Orthop Sci. 2014; 19(1): 1–5. Published online 2013 Dec 4. doi: 10.1007/s00776-013-0495-x
[3] The pathology of frozen shoulder.
Hand GC, Athanasou NA, Matthews T, Carr AJ.
J Bone Joint Surg Br. 2007 Jul;89(7):928-32.
Jain TK, Sharma NK.
J Back Musculoskelet Rehabil. 2014;27(3):247-73. doi: 10.3233/BMR-130443.
Yang JL, Chang CW, Chen SY, Wang SF, Lin JJ.
Phys Ther. 2007 Oct;87(10):1307-15. Epub 2007 Aug 7.
Smith CD, Hamer P, Bunker TD.
Ann R Coll Surg Engl. 2014 Jan;96(1):55-60. doi: 10.1308/003588414X13824511650452.
[7] Frozen shoulder: the effectiveness of conservative and surgical interventions–systematic review.
Favejee MM1, Huisstede BM, Koes BW.
Br J Sports Med. 2011 Jan;45(1):49-56. doi: 10.1136/bjsm.2010.071431. Epub 2010 Jul 20.
