Frozen shoulder, otherwise known as adhesive capsulitis, is a very common condition in which the shoulder joint stiffens, thus reducing its mobility over time. Commonly, this condition affects individuals between the ages of 40- 60, and occurs more in women than in men.
Fortunately, after a period of worsening, frozen shoulders usually loosens or “thaws” over time, however this can take months and even years. In severe cases symptoms and impairments can become permanent if not treated. Physical Therapy, with a focus on shoulder flexibility, is one of the primary treatment recommendations for this condition.
Anatomy of the Shoulder
The shoulder is a ball-and-socket joint made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle).
The head of the humerus fits into a shallow socket in the scapula. Strong connective tissue, called the shoulder capsule, surrounds the joint.
To help the shoulder move more easily, synovial fluid (a viscous, non-Newtonian membrane surrounding the joints) lubricates the shoulder capsule and joint which helps ensure smooth and easy body movement.
Symptoms
The shoulder capsule is connective tissue that encases the shoulder joint filled with synovial fluid lubricating the joint. Frozen shoulder is a condition where thick bands of tissue called adhesions develop in the capsule and there is a decrease in synovial fluid. This causes the shoulder to become stiff, tight and inflamed making it harder to move.
The hallmark signs of adhesive capsulitis are severe dull or achy pain and the inability to move your shoulder- whether on your own or with assistance. Reaching for items becomes difficult, if not impossible. Pain can radiate down into lower arm and neck pain can be a symptom as well as the muscles and joints above and below the shoulder tend to compensate. Pain usually worsens and persists during the night, which makes it difficult to sleep.
Frozen Shoulder is broken down into 3 stages:
Stage 1 (Freezing):
- Developing pain in your shoulder any time you attempt to move it
- Gradually worsens over time and may hurt more at night
- Lasts around 6 to 9 months
- Limited in how far your shoulder moves
Stage 2 (Frozen):
- Decreased pain but stiffness gets worse
- Moving the shoulder becomes more difficult and it becomes harder to get through daily activities
- Lasts 4 to 12 months
Stage 3 (Thawing):
- Movement of the shoulder starts to go back to normal
- Complete return to normal or close to normal strength
- Takes around 6 months to 2 years
Causes
The causes of this condition are not fully understood. Neither hand dominance nor occupations are considered to be clear connections as contributing factors. Frozen shoulder occurs more often in women than in men, and has a greater incidence between the ages of 40 to 60.
Other causation theories include hormonal imbalances, or a weakened immune system which both make you more likely prone to joint inflammation. Being immobile for long periods of time due to an injury, illness or surgeries such as mastectomy also makes you vulnerable to adhesions and inflammation.
Certain medical conditions such as diabetes can increase the risk of frozen shoulder. About 10%-20% of people with diabetes get frozen shoulder. Heart diseases, thyroid diseases, stroke or Parkinson’s disease are also associated with frozen shoulder as well.
Treatments:
It is always advisable to consult your medical doctor for severe and persistent symptoms. Typical initial treatment includes over-the-counter anti-inflammatory drugs like aspirin, naproxen sodium or ibuprofen followed by prescription anti-inflammatories and/or pain medication. Physical therapy is also common treatment for frozen shoulder.
The goal of physical therapy is to incorporate strengthening and stretching exercises to regain the shoulder’s lost motion and improve its mobility while controlling pain. It can take anywhere from a couple of weeks to months to see the progress. Your physical therapist will provide instructions on the types of exercise you should do and how often to do them. Most importantly is the prescription and compliance to your physical therapy home exercise program provided by your PT which consists of gentle range of motion exercises and symptom control strategies. Most people recover from frozen shoulder without the need of invasive and surgical interventions.
The body ultimately tries to heal itself and statistically most people recover within two to three years without treatment.
Early diagnosis and treatment with medications and physical therapy can prevent advanced frozen shoulder and lessen the duration of symptoms.
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