Understanding Frozen Shoulder

 

Frozen shoulder, known medically as adhesive capsulitis, causes pain and stiffness in the shoulder joint. Over time, the shoulder becomes progressively harder to move.
Statistically frozen shoulder occurs in about 2% of the overall population; most commonly affecting people between the ages of 40 and 60 with women more affected than men.

Anatomy of the Shoulder

The shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus fits into a socket in the scapula. The joint is surrounded by strong connective tissue, called the shoulder capsule. Inside the joint synovial fluid lubricates the shoulder capsule and the joint.

The shoulder capsule surrounds the shoulder joint and rotator cuff tendons. Reproduced and modified from The Body Almanac. (c) American Academy of Orthopaedic Surgeons, 2003.

What happens to the joint in frozen shoulder?

The joint becomes inflamed; the shoulder capsule thickens and becomes stiff, tight, and inflamed. Stiff bands of tissue called adhesions develop. In many cases, there is less synovial fluid in the joint. The hallmark sign of this condition is reduced range of motion in the shoulder joint. Frozen shoulder develops in three stages:

Freezing- In the “freezing” stage, you slowly have more and more pain. This is the stage where the shoulder is acutely inflamed. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
Frozen- Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.
Thawing- Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion can take from 6 months to 2 years.

In frozen shoulder, the smooth tissues of the shoulder capsule become thick, stiff, and inflamed.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes- Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.

Other diseases- Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Immobilization- Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Symptoms of Frozen Shoulder

Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease (the inflamed stage) and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm. Frozen shoulder generally gets better over time, however without treatment it can take up to 3 years.
The focus of treatment is to control pain and restore motion and strength through physical therapy.

Treatment of Frozen Shoulder

More than 90% of patients improve with manual therapy (massage) and an exercise/stretching regime (described below).

Therapeutic Ultrasound- Ultrasound has been found to be beneficial in frozen shoulder when used in conjunction with manual therapy (massage).

Non-steroidal anti-inflammatory medicines- Drugs like aspirin and ibuprofen reduce pain and swelling.

Steroid injections- With stubborn cases cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.

Treatment in our Clinic

A typical frozen shoulder treatment in our clinic involves massage and manual therapy to all structures surrounding the joint as well as trigger point therapy to all affected muscles. Then a course of therapeutic ultrasound is administered followed by gentle joint mobilizations to increase range of motion within the shoulder joint. This is a stubborn condition that takes time to resolve, but it typically responds well to treatment. The patient must be willing to do their home exercises to see continued improvement in their condition.