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Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder is a condition characterized by inflammation and stiffness of the connective tissue that covers the shoulder joint.

Sometimes the articular pock of the shoulder joint becomes inflamed and “tightens” the joint. When this happens then we have frozen shoulder syndrome.

frozen shoulder

In general, frozen shoulder syndrome can be divided into three stages:

  • Painful stage: In the first stage there is pain in all movements of the shoulder. Also at this stage the shoulder stiffness begins.
  • Stiffness stage: The second stage of the frozen shoulder is characterized by a great lack of movement, due to the scar tissue that develops in the joint pocket. Patients have great difficulty reaching the hand back to their back. The pain at this stage begins and subsides.
  • Stage of remission of symptoms: At this stage the symptoms begin to subside as the shoulder becomes more relaxed and moves comfortably.


Although the exact cause is not known, some injury to the shoulder joint or adjacent tissues is thought to be responsible. Frozen shoulder is more common in cases where proper treatment has not been applied. It is also more common in cases where the shoulder has been immobilized for a long time (eg after surgery), if the patient has diabetes or another autoimmune disease.


Symptoms associated with a frozen shoulder develop gradually. Initially, patients experience a shoulder discomfort that develops into “sharp” pain with specific movements or activities. The pain is deep in the shoulder, although sometimes there is discomfort in both the arm and the neck. In the above areas there is stiffness. The pain associated with frozen shoulder syndrome increases with all shoulder movements.

Activities such as raising the hand, carrying, lifting objects, pushing or pulling, shoulder pressure during sleep, loosening a bra increase the symptoms. A common phenomenon is night pain and pain in the first days of the day. When we move to the second stage of the frozen shoulder then the pain begins to decrease. In addition to pain, patients with frozen shoulder have a high degree of stiffness in the shoulder joint. Stiffness affects all shoulder movements but more the lifting and turning.


Subjective (history taking) and objective (clinical examination) evaluation are sufficient to lead the physiotherapist to diagnose frozen shoulder syndrome. Sometimes tests such as MRI scans can help.


Once frozen shoulder syndrome appears, a few things can be done to speed up recovery. The best treatment is prevention. For this reason, any shoulder injury must be completely healed, according to the treatment protocols prepared by the physiotherapist in each case.

The goal of treatment once frozen syndrome is established is to maintain shoulder mobility and strength, as well as reduce pain. It is very important to avoid activities and increase the symptoms. This helps our body heal damaged tissues and reduce inflammation.


In some cases the frozen shoulder subsides after months. Rarely do the symptoms go away after eighteen months or more. The painful stage usually lasts from two to six months. The stage of stiffness lasts four to twelve months and the last stage of recovery four to eighteen months.

Prognostic factors of frozen shoulder syndrome

There are several factors that contribute to the development of frozen shoulder. They all need to be evaluated and corrected during rehabilitation by the physiotherapist. Some of them are:

  • History of shoulder surgery
  • Inadequate / inadequate treatment after injury or shoulder surgery
  • Diabetes
  • Autoimmune Diseases
  • Age over 40

Physiotherapy for frozen shoulder syndrome

  • Soft molecule techniques (massage)
  • Electrotherapy
  • Taping
  • Exercises to improve the elasticity of the shoulder muscles
  • Education – tips
  • Articular mobilization (manual therapy)
  • Hydrotherapy
  • Dry needle technique
  • Thermotherapy