Is your shoulder tight, sore and not really doing what it should? Are you over 40 (so young I know)? You may have developed a frozen shoulder. Ouch.
Adhesive Capsulitis better known as “Frozen Shoulder” is a condition of the shoulder characterised by inflammation, scarring and tightening of the connective tissue surrounding the shoulder joint.
Frozen shoulder usually results in shoulder pain, a marked loss of shoulder movement and can be very debilitating with functional activities. Frozen shoulder is believed to affect 2-5% of the population and up to 20% of patients with diabetes. Frozen shoulders most commonly occur in patients over the age of 40 and more so in women compared to men. It has an insidious onset meaning there does not need to be any injury as such to trigger the process however in some cases it is a result of a minor injury that has not been dealt with adequately.
Frozen shoulders are generally divided into three phases, each of which can last a number of months.
- Pain – In this phase of a frozen shoulder the shoulder typically becomes painful with most movements, the shoulder may also start to stiffen up but the main complaint is pain especially with sleeping on the affected side and movement of the shoulder behind the back.
- Stiffness (Freezing) – The second phase of this condition is characterised by a marked loss of movement of the shoulder, coinciding with scarring of the shoulder joint capsule. During this stage the pain tends to ease but stiffness becomes the main issues, again elevating the shoulder, and functional restrictions like combing hair and putting on bra’s becomes very difficult.
- Resolution (Thawing) – In the final phase the shoulder spontaneously begins to “loosen up”, movement gradually restores and function returns.
What causes a frozen shoulder ?
The exact cause of a “frozen shoulder” is not known, it is thought to occur after an injury to the shoulder joint and adjacent soft tissue however can be insidious with no underlying injury at all. A frozen shoulder is more likely to develop if the initial injury is not treated appropriately. A patient may also have an increased likelihood of developing the condition following excessive immobility (i.e. not moving the shoulder, particularly after injury or surgery) or if they suffer from other auto-immune disease or diabetes.
Signs and symptoms of a frozen shoulder
The symptoms associated with this condition usually develop gradually over time (often following a recent history of shoulder injury, surgery and or/ immobilisation). Typically you will experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be deep in the shoulder however occasionally pain can be experience in the upper back, upper arm and neck with associated stiffness in these areas.
Pain may increase with any movement of the shoulder and with activities placing stress on the shoulder joint, this can include elevating the arm, lifting the arm, carrying, pushing or pulling, lying on the affected side and putting your hand behind your back (e.g. putting on a bra).
As the condition progresses from the painful phase to the frozen phase the pain may reduce significantly. As previously mentioned stiffness and reduced range of movement of the shoulder is a typical sign of frozen shoulder. If you are noticing these symptoms you may be in phase 2 of a frozen shoulder.
Frozen shoulder generally affects only one side however some patients may develop the condition in both shoulders.
Contributing factors to the development of frozen shoulder
- History of a recent shoulder injury
- History of recent shoulder surgery
- Inappropriate treatment following shoulder injury or surgery (particularly inadequate or excessive rest)
- Women > Men
- Age > 40
- Poor posture
Diagnosis of a frozen shoulder
If any of the above sounds like it relates to you diagnosis will be made by your physiotherapist after a thorough subject and objective examination. Your physiotherapist will go through a number of tests and a detailed assessment before coming up with their potential diagnosis.
Treatment of a frozen shoulder
Once a diagnosis is made a treatment program will be put in place to assist in the recovery process. The aim of physiotherapy will be to determine what phase of the process you are in. Your physiotherapist will provide you with education and advice regarding adequate rest and exercise to help with the recovery process without causing any further pain or damage. If you’re not progressing adequately your physiotherapist will also be able to refer you on to any relevant specialists if they feel this is required.
Prognosis of a frozen shoulder
Most cases of frozen shoulder settle after a number of months, in severe cases, symptoms may be present for up to 18 months or longer. Usually the painful stage lasts for 2-6 months, the frozen phase can last from 4-12 months and the thawing phase can last an additional 4-18 months. In some cases patients may experience ongoing and permanent restriction in movement following completion of all three stages, however most cases of frozen shoulder will have a good outcome. Though this condition has a lengthy recovery process it is imperative that it is managed and monitored. Incorrect exercises, inadequate exercise over stretching or lack of movement can complicate the recovery time. Your physiotherapist is best equipped to manage and treat this condition.
If you feel that you may have a frozen shoulder let us help you out.