What is a ‘frozen shoulder’ and why does it happen?
A ‘frozen shoulder’ is a simpler way of saying you have adhesive capsulitis. Symptoms begin slowly and get worse over time.
Those who have suffered from it will tell you it causes an enormous amount of pain. Some people are lucky enough to recover quickly, but sadly some people can endure symptoms for up to 4 years.
Inactivity can worsen symptoms and muscle loss can occur over weeks or months, in rare cases there can even be bone fracture or tendon rupture of the biceps brachii muscle. I tell patients who are diagnosed with it that that the best course of action is to work hard and get it moving as soon as they can. I like to ‘mobilise’ the glenohumeral (shoulder joint) to help encourage the flow of synovial fluid which lubricates the ball and socket joint. I also work deeply into the surrounding rotator cuff to release some of the pressure that’s built up during the inflammation and fibrosis. Trigger point therapy and frictions work incredibly well.
I prescribe range of motion exercises for the shoulder and usually with a combination of manual therapy and movement it gets a lot better. Sometimes it can spread to the other shoulder so it’s important to keep both exercising and as mobile as they can be. I work with the whole body as always but the mid back and neck are fundamental areas to care for.
But why? It’s a great question and I’m asked a lot.
There are risk factors, and they include the following:
Diabetes
Thyroid issues
Hormonal changes especially during menopause
Shoulder pathology
Shoulder surgery
Open heart surgery
Cervical disc issues in the neck
Victims of stroke
Women post mastectomy
Women seem to be more likely to get it between the ages of 40-60 years. If you have suffered tendonitis or bursitis, you might also be prone. Diabetic patients are 5 times more likely to suffer from it as well as those suffering complications from thyroid issues (Chuang, 2023; Dyer, 2023).
There are 3 stages to adhesive capsulitis:
Stage 1: ‘Freezing’ locking of the joint and the most painful. It can last between 6 weeks to 9 months and is incredibly frustrating. The pain worsens and the range of motion declines.
Stage 2: ‘frozen’ or adhesive stage where movement is slow to return but improves a little, but pain remains. The stiffness can last for up to 12 months
Stage 3: ‘Thawing’ which usually means patients are on the mend and movement is noticeably improving. Pain subsides and locking eases up. This can be up to 25 months.
The most important element that defines a frozen shoulder during examination in clinic is lack of external rotation (Chiang, 2016) and restricted motion in both active and passive movements. This makes it different to impingement problems in the rotator cuff and tendonitis where the active range may be clearly compromised but passive is not.
References
Chiang, J. and Dugan, J. (2016) ‘Adhesive capsulitis’, JAAPA, 29(6), pp. 58–59. doi:10.1097/01.jaa.0000482308.78810.c1.
Chuang, S.-H. et al. (2023) ‘Association between adhesive capsulitis and thyroid disease: A meta-analysis’, Journal of Shoulder and Elbow Surgery, 32(6), pp. 1314–1322. doi:10.1016/j.jse.2023.01.033.
Dyer, B.P. et al. (2023) ‘Diabetes as a risk factor for the onset of frozen shoulder: A systematic review and meta-analysis’, BMJ Open, 13(1). doi:10.1136/bmjopen-2022-062377.
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