Does your shoulder feel ‘stuck’? Is your shoulder pain so great you can barely lift your arm? Does your shoulder make even getting dressed difficult? If so, you could be suffering from adhesive capsulitis, also known as frozen shoulder.
What is Frozen Shoulder?
Frozen shoulder, also called adhesive capsulitis, is the creation of adhesions and fibrosis of the capsule of the shoulder. The capsule is the soft tissue envelope that surrounds the shoulder joint. Flexibility of the capsule is required in order for normal shoulder motion to occur. In frozen shoulder, the capsule begins to thicken and in a way, becomes vacuum sealed around the shoulder joint. This change most noticeably occurs in the inferior or bottom aspect of the capsule.
Although the creation of adhesions and fibrosis has a strong inflammatory component, there is also evidence of an autoimmune or systemic cause. People with a history of thyroid conditions and diabetes are more likely to have frozen shoulder. Adhesive capsulitis most commonly occurs between the ages of 45 and 60 and occurs more frequently in women than in men. The onset of this condition may, but generally does not, occur secondary to a trauma.
The most common signs and symptoms of adhesive capsulitis are shoulder joint pain and decreased mobility in the shoulder. The amount of pain and loss of shoulder mobility depends on the stage. There are three general stages to frozen shoulder: freezing, frozen, and thawing.
Freezing stage: generally characterized by significant joint pain and decreasing shoulder mobility. During the freezing stage, pain is the primary issue. The freezing stage can last 3 to 9 months. Pain is significant both at rest and with movement. Pain is specifically noted at night and can greatly interrupt sleep. Because the pain is so great, use of the arm becomes less for daily activities such as eating, dressing, and reaching.
Frozen stage: generally characterized by much less joint pain but significant restriction in mobility. During the frozen stage, a lack of mobility is the primary issue. This stage can last 3 to 6 months. If pain occurs during this stage it is generally not at rest but occurs with active motion. The shoulder does not feel as painful but it simply does not want to move.
Thawing stage: generally characterized by a gradual return of normal shoulder mobility. Duration of this phase is variable. Generally frozen shoulders will improve over a total of 24 months (from freezing to thawing). Minimal pain is present during this stage and over time, shoulder range of motion returns to near normal.
The emphasis for treatment is directly affected by the specific stage of the frozen shoulder.
In the freezing stage, pain reduction is of primary importance. The use of anti-inflammatory medication (consult your doctor regarding medication) as well as the use of ice therapy can help reduce the pain and inflammation. During this stage, cortisone injections can also be helpful to reduce pain and inflammation. Although performing shoulder range of motion exercises can be helpful in minimizing the loss of mobility, pain often significantly limits stretching tolerance.
During the frozen and thawing stages, stretching and mobilization of the shoulder can be beneficial in regaining shoulder mobility. Physical therapy can be helpful to manually mobilize the shoulder joint. It is important to note that the shoulder must be stretched past the point of resistance. Unfortunately this means the stretches can be rather uncomfortable. In addition, there is some evidence that longer, lower intensity stretches are more effective then short intense stretches. Because stretching can be uncomfortable and irritating, utilizing ice after stretching is recommended.
In some cases, your doctor may recommend a manipulation. With a manipulation, the shoulder joint is forcibly moved through the range of motion while you are under anesthesia. The goal is to stretch, and in some cases, tear the joint capsule. A risk to this procedure is that the capsule may not be the only tissue stretched or torn. In some cases, manipulation is a reasonable treatment option. However, recovery from a manipulation is painful and will require dedication to post-operative physical therapy stretching.
The typical physical therapy protocol for frozen shoulder will include modalities, joint mobilization, and stretching. Modalities such as ice, ultrasound, TENS, and iontophoresis can all be helpful in reducing pain. Joint mobilizations performed by the physical therapist are the means of improving mobility of the joint capsule. Although mobilizations can be uncomfortable they are vital to improving shoulder range of motion. Finally, self stretching is vitally important to regaining normal shoulder mobility. Again, because of the nature of the condition, stretching exercises will be very uncomfortable. Consistency will pay off as range of motion and functional use of your shoulder improves..
A wide variety of disorders can result in a stiff shoulder. These conditions range from tightness in certain areas of the shoulder joint as in a throwing athlete with tightness in the back of the shoulder to a more global loss of motion as in a person with a “frozen shoulder.”
Throwing or overhead athletes can develop a disorder called glenohumeral internal rotation deficit (GIRD). Repetitive throwing causes scarring of the back of the shoulder joint. This, in turn, changes the mechanics of the shoulder resulting in loss of internal rotation of the shoulder, pain, and often, muscle tears. Overhead athletes complain of pain in the back part of their shoulder when their arm is in the “cocking” and/or “acceleration” phases of throwing and complain of tightness when the arm is brought across the body or behind the back. Treatment should be centered on stretching the back shoulder muscles and strengthening the rotator cuff or front muscles of the shoulder. It’s also important for pitchers to work on stabilizing and strengthening the shoulder blade. Also, overhead athletes, particularly young throwers, should adhere to pitch count guidelines and continually have their throwing motion evaluated to look for flaws that may contribute to this condition. For information on preventing youth pitching injuries, visit www.STOPSportsInjuries.org.
A “frozen shoulder” is a more global loss of motion, where the shoulder is tight in several different positions. “Primary frozen shoulder,” also known as “adhesive capsulitis,” is a condition which is more common in 40- to 60-year-old women or people with diabetes or thyroid problems. It can be following a minor injury to the shoulder,or more commonly, develop without a particular event. The cause of this condition is not entirely clear, but scar tissue forms in all portions of the joint, most often starting in the front of the shoulder. This disorder goes through the following distinct phases: the “freezing” or inflammatory stage during which pain develops and motion loss occurs, the “frozen” stage where there is significant loss of motion, but decreased pain, and the “thawing” phase where there is a gradual return of motion. In a majority of patients, the shoulder “thaws out” on its own without surgical intervention, but this process may take anywhere from six months to two years. Cortisone injections in the early inflammatory phases and gentle physical therapy may expedite the process. Rarely, manipulation of the shoulder under anesthesia with surgical release of the scar tissue is needed to regain motion.
If one starts developing shoulder stiffness, it is important to be evaluated by a medical professional familiar with shoulder disorders to get an appropriate diagnosis and treatment plan. Often these conditions are misdiagnosed and inappropriate treatment is undertaken initially, prolonging recovery..
2013 Copyright © Michael T Havig MD PL. All Rights Reserved. Web Design by RT Design Group