Frozen shoulder tends to cause stiffness and pain in the shoulder. Over the course of time, the shoulder
ends up becoming very hard to move. The condition only occurs in around 2 percent of the population.
Most of the time, it affects individuals who are between 40 and 60 years of age. It occurs more often in
women than it does in men.
The most common time to get frozen shoulder is following shoulder surgery, especially rotator cuff repair
and shoulder decompression. This is probably due to the extent of arthritis in the shoulder that needed to
be “cleaned-out”, which causes trauma to the shoulder. The resultant pain prevents mobility in the
shoulder which then leads to stiffness. The stiffness gets worse and within two weeks the shoulder can be
Other issues after surgery involve the use of a sling to protect the rotator cuff. A lack of mobility to the
shoulder leaves the shoulder joint at risk of developing frozen shoulder (sometimes known as secondary
How to Treat Frozen Shoulder:
Ibuprofen and aspirin can help to reduce swelling and pain. As the swelling decreases, the
amount of pain that accompanies it will diminish as well. However many therapists discourage
the use of anti-inflammatories because frozen shoulder takes a long time to resolve (often many
months) and using anti-inflammatories for more than 2 weeks is not recommended.
Cortisone is a powerful form of an anti-inflammatory medication that can be injected directly into
the shoulder joint. It can give patients a step-forwards but very rarely cures a frozen shoulder.
High Volume Injection
Sometimes called hydrodilatation, a high volume of saline and steroid are injected into the
shoulder capsule with the intension of stretch the capsule from the tight adhesions. The
procedure takes about 15 minutes and is usually done under X-ray or ultrasound. Results vary but
most people (around 70%) report some benefit from the injection.
Performing specific exercises can help to restore motion. This can be under the direct
supervision of a trained therapist or performing them in the comfort of your own home. Therapy
entails stretching and range of motion exercises for the shoulder joint. You can use a heat source
or hot water bottle for loosening the shoulder before engaging in any stretching exercises.
Therapists might also use other modalities including acupuncture, electrotherapy, ice and heat
treatment and ultrasound.
• Frozen shoulder tends to occur more often in those who have diabetes, affecting around 10 to 20
percent of individuals. The reason isn’t known at this time.
• Frozen shoulder often develops following a shoulder surgery that has left the joint immobilized
due to the surgery, fracture or other type of injury.
• Moving your shoulder soon after your surgery is one of the best methods for preventing frozen
• Pain is often aching or dull. During the early part of the disease, the pain tends to be worse when
you are able to move your arm. It is located over the outer part of the shoulder and into the
• Follow the exercise rehab plan from your therapist. Failure to do regular exercises will
significantly slow your recovery
Shoulder impingement syndrome
Shoulder impingement syndrome is a very common shoulder problem that causes a pinching of one of
the tendons in the shoulder.
It tends to occur commonly within the shoulders of the over 50s, although not exclusively, and can occur
in younger patients but is rarely seen below the age of 30.
When injuries to the rotator cuff tendons occur, the tendon responds by swelling similar to the way
ankles do when they are sprained. Since the rotator cuff muscle is surrounded by bone, the swelling can
cause numerous events to occur. As the tendon swells, there is not much space under the bone at the
top of the shoulder blade, and when lifting your arm, the tendon can catch or impinge under the bone.
This causes scratching or inflammation to the tendon, resulting in more swelling. The more the tendon
swells, the less space there is for the tendon to move, and the impingement becomes worse, causing
more swelling, and resulting in a complicated vicious circle that can take months or even years to resolve.
What Causes Shoulder Impingement?
There are a number of causes of shoulder impingement:
Arthritis of the ACJ
Wear and tear on the ACJ can cause something known as hypertrophy which is thickening of the
joint. There could also be bone spurs. This decreases the space under the joint and can cause
impingement of the rotator cuff tendon.
A low lying or hooked acromion can decrease the space underneath the ACJ and cause
impingement of the rotator cuff tendon. Often classified in three grades, I II and III. Grades II and
III can be surgical cases.
Subacromial bursitis is a swelling of the fluid filled sac under the ACJ and if this becomes inflamed,
there is less space for the rotator cuff tendon causing impingement.
Poor posture puts the shoulders forwards and elevates the shoulder blade which can cause
Repetitive Strain to the Tendon
Repeated pressure and use (e.g. in golfers, or other sports people) can cause inflammation of the
rotator cuff tendon (known as tendinopathy). This causes swelling, and then impingement.
Rotator Cuff Tear
If the rotator cuff tendon weakens enough through impingement, it can tear causing a partial
thickness or full thickness rotator cuff tear.
How to Treat Impingement Syndrome:
An anti-inflammatory medication is one of the most common forms of treatment for this
condition. However, caution should be advised because shoulder impingement is a chronic
condition typically lasting 6-12 months, so look for more natural alternatives such as ice, heat,
exercises and manual therapy.
Daily stretching exercises are beneficial. Your therapist will guide you.
If you still have persistent symptoms but have tried exercises and manual therapy, a
cortisone/steroid injection into the area might be needed. A steroid commonly used is depomedrone, with a local anaesthetic called lidocaine. Depo-medrone is a strong anti-inflammatory
that can help reduce pain and inflammation in the shoulder.
Place an ice bag on the tip of the shoulder and do this every day for a few weeks. It takes a long
time but shoulder impingement is hard to shift, so doing the ice will help. Ask your therapist how
long to use the ice for. If ice doesn’t help, try heat.
Seek help from a physiotherapist, osteopath, chiropractor, sports massage therapist or other
manual therapist because these problems are stubborn and take a lot of therapy to get them to
disappear. Without treatment, there is a possibility you will have further problems.
• Impingement often results from sports that place an undue amount of stress on the shoulder.
• The condition tends to develop more often in those who are aged 30 or older.
• Warehouse workers, assembly-line workers and athletes are at an increased risk of developing an
• Osteoarthritis, bone spurs and degenerative disease tend to leave individuals more susceptible to
• Avoid sleeping with your arm raised above your head at night, or on the affected side.