You may have heard Frozen Shoulder being termed ‘adhesive capsulitis’ in the medical world. To understand the condition a little more think of the shoulder joint as a ball and socket, that is surrounded by a capsule like structure. The condition arises when strong connective tissue surrounding the shoulder joint (the capsule), becomes thick, stiff and inflamed. The joint capsule contains ligaments that attach the top of the upper arm bone and the shoulder socket, securely holding It in place (the ball and socket). When Frozen Shoulder develops the joint becomes inflamed and scar tissue forms. As this happens, the capsule shrinks and hardens, making the shoulder painful and harder to move. Use it or lose it! The more pain that is felt, the less likely the shoulder is to be used, increasing thickening of the shoulder capsule, and freezing in position.
Frozen Shoulder can be painful and mysterious, and is regularly proceeded by periods of immobilisation, or trauma to the shoulder joint. Therefore, the two main symptoms are typically pain, and a noticeable decrease in range of motion, or more functionally put; a decreased ability to perform tasks such as reaching bra clasps and raising your arm above your shoulder.
Evidence largely suggests that those with the below pre-conditions are at an increased risk of developing Frozen Shoulder;
• Diseases affecting the thyroid gland; a gland in the neck that produces hormones and controls how the body uses and stores energy
• Diabetes; people with this condition have a 10-20% increased risk of developing Frozen Shoulder
• Aged over 50 years
• Women aged 45-55; suggesting that some hormonal factors are believed to be involved as it occurs more commonly in women rather than men.
The worst cases of Frozen Shoulder are dominated by capsule tightness. Although it is painful to move your shoulder, the pain is not a sign of damage but a reaction as the capsule stretches. Muscle guarding, a term used to explain muscles becoming tight to protect joints, is also a major contributing factor to reduced range of motion in patients with Frozen Shoulder and increased pain levels.
People who have Frozen Shoulder often go through three phases of symptoms
• The first phase involves severe shoulder pain that is usually worse at night, followed by gradual symptoms of stiffness in the joint
• In the second phase, the pain gradually lessens, but stiffness increases in a way that general mobility and function is limited
• In the third phase gradual gains are made as limitations in range and mobility begin to cease
People who develop Frozen Shoulder on one side will may go to develop it on the other. While your good shoulder is compensating and working twice as hard, it may also be forming an overuse injury. Compensation means that almost 10% of patients with the condition will have it in both shoulders. While you may be preoccupied with one painful shoulder, it is important to remember to take care of your good shoulder and know what symptoms you should be looking out for. Know the signs and let your treating physiotherapist know if you suspect you are developing symptoms in both arms.
Physiotherapy should be the first line of treatment to seek proper diagnosis. As a general rule the condition itself is self-limiting, meaning it may get better by itself, but for unknown reasons, it can take up to several years to resolve. Often exercises are prescribed incorrectly or progressed too soon. This can be detrimental to a shoulder with the frozen shoulder condition. Knowing what activities, you should and should not be doing is crucial to minimising your recovery time and decreasing progression of the condition. At Maxvale Physiotherapy, our physiotherapists will advice you the appropriate exercises and management strategies to maximise your recovery.
The mainstay for treatment should be to use the arm as much as possible, within the limits of your discomfort. You should not immobilise the arm or stop using it as this will cause the condition to deteriorate. You need to see a physiotherapist to be taught an appropriate series of shoulder exercises and undergo manual treatment to relax and stretch the capsule. The exercises can sometimes be painful and should not include any aggressive stretching exercises in the early stages. The aim of the exercises is to keep the shoulder mobile and avoid further stiffness.
Because of the vague and insidious nature of Frozen Shoulder, a lot of research suggests differing views on treatment options, highlighting the importance of consistent clinical experience in managing the condition. For example;
• Evidence would say to begin shoulder exercises / strength training early, but clinical experience shows not to start strengthening until range of motion has been largely restored.
• Some stretching exercises prescribed in most Frozen Shoulder handouts can be harmful depending on the individual and may often progress the condition further Frozen Shoulder is a complex condition and can pose some inconvenient limitations for any individual. It will often have major impacts on physical function, upsetting the personal, professional and social lives of those affected.
Research will tell you that the condition will last anywhere from 12-36 months. At Maxvale Physiotherapy, we treat on a case to case basis, ensuring that the treating protocol is individualised, and are equipped with extensive practical experience to allow us to decrease this time frame to three short months.
Written by Bethany Logan, APAM Physiotherapist
Photo by Karolina Grabowska
References: Eljabu, W., Klinger, H. M., & von Knoch, M. (2016). Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review. Archives of orthopaedic and trauma surgery, 136(1), 1-7. Ewald, A. (2011). Adhesive capsulitis: a review. American family physician, 83(4), 417-422. Guyver, P. M., Bruce, D. J., & Rees, J. L. (2014). Frozen shoulder–A stiff problem that requires a flexible approach. Maturitas, 78(1), 11-16. Jain, T. K., & Sharma, N. K. (2014). The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. Journal of back and musculoskeletal rehabilitation, 27(3), 247-273. Uppal, H. S., Evans, J. P., & Smith, C. (2015). Frozen shoulder: A systematic review of therapeutic options. World journal of orthopedics, 6(2), 263.