Frozen Shoulder
Frozen shoulder is a relatively common condition that can have a significant impact on a person’s life. A person with a true frozen shoulder usually experiences a significant loss of motion and a significant amount of pain.
About Frozen Shoulder
Frozen shoulder affects roughly 2 to 5% of the population, and it tends to show up more often in women between the ages of 40 and 65. Also called adhesive capsulitis, it can be linked to certain health conditions such as diabetes or thyroid problems, but not always. For many patients, frozen shoulder starts for no apparent reason in an otherwise healthy person.
Why is my shoulder stiff?
The precise mechanism of frozen shoulder is still relatively unknown. That being said, it is generally understood that some form of “event” causes the cells in your shoulder to change their activity. Inflammation likely causes the different tissues in the shoulder to contract or “bear down” on the joint. As a result it is very difficult to move, almost as if there is a type of “debris” in the way.
Is It Really Inflammation?
Here is where our understanding has shifted. For a long time the condition was called adhesive capsulitis, a name that implies the capsule of the shoulder is inflamed and adhered to the bone. More recently, some researchers have started using the term frozen shoulder contracture syndrome instead. The reason is that when they look closely, they often do not find many inflammatory cells, and the capsule does not appear to be stuck to the head of the arm bone the way we once assumed. Instead, the main drivers seem to be fibrosis (a build-up of scar tissue) and neovascularity (changes in the blood supply to the area). We still do not fully understand why this happens, especially in people without any of the usual risk factors, but it is a good example of how the picture keeps changing as the research catches up.
Symptoms of Frozen Shoulder
A person with frozen shoulder will likely feel pain when they move the shoulder to the end of its available range. Often the shoulder will not hurt much through a short range and will not really hurt at rest. The hallmark of the condition is loss of motion, and it has a fairly specific pattern: external rotation (twisting the arm outward) and abduction (lifting it up to the side) are usually the most limited. That loss of movement is often more noticeable when someone else moves your arm for you (passive movement) than when you move it yourself. Contrary to popular belief, the muscles are not damaged or weakened in any significant way. It feels like they must be torn, but they usually are not. The joint simply will not move.
Tests for Frozen Shoulder
Unlike many conditions, there really aren’t any imaging findings for a practitioner to look for. When a person presents to our clinic with pain, loss of movement and no obvious findings on x-ray, diagnostic ultrasound or MRI, frozen shoulder is a diagnostic possibility. Imaging is still useful, but mainly to rule out other causes rather than to confirm frozen shoulder itself.
One movement that gets reduced during frozen shoulder is internal rotation. Do you have difficulty with the movement shown below?
Phases of Frozen Shoulder
It’s important for people with frozen shoulder to have a realistic expectation of the healing rate. Although some lucky individuals recover relatively quickly, many patients experience symptoms for over a year, and the statistical average for the whole process runs close to thirty months. The first phase lasts roughly 3 to 9 months. This is the “freezing” period, which involves progressive pain and loss of motion.
Second Phase of Frozen Shoulder
The second phase typically occurs between 9 and 15 months from onset. At this point the shoulder is stiff: frozen shoulder has arrived.
Recovery from Frozen Shoulder
The last phase is often referred to as the “thawing” phase. It can occur between 15 and 24 months and involves a relatively gradual return of mobility. It is reasonable to expect the shoulder to recover to close to its pre-injury status, but that may take quite a while.
Treatment for Frozen Shoulder
The treatment for frozen shoulder really depends on the phase of development and how much pain the patient is in. Conservative treatment (like chiropractic or physiotherapy) is usually recommended and involves things like stretching, assisted stretching, active release technique and other forms of manual therapy, laser therapy, interferential current, graston, massage therapy and acupuncture. Home exercises focused on mobility and strengthening are an integral part of recovery. Sometimes a combination of these approaches does the job. For those with very painful frozen shoulder, corticosteroid injections can be helpful. Surgery is also an option for those who fail to respond to conservative treatment (like physiotherapy or chiropractic). Unsure if you even have a true frozen shoulder? Want to know your options for treatment?
Call or email us – info@burlingtonsportstherapy.com. We can help you!
References
Favejee M, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions, systematic review. British Journal of Sports Medicine 2011; 45: 49-56.
Kelley MJ, Shaffer MA, Kuhn JE et al. Shoulder pain and mobility deficits: adhesive capsulitis, clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy 2013; 43(5): A1-A31.
Lewis J. Frozen shoulder contracture syndrome, aetiology, diagnosis and management. Manual Therapy 2015; 20(1): 2-9.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 135-148.
