Frozen Shoulder

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Frozen shoulder affects your shoulder joint and causes, as its main symptoms, gradual emergence of pain and stiffness in the joint. These symptoms increase over time and then eventually recede and disappear over a period of 1-3 years. These symptoms eventually disappear on their own in most cases. As a result, treatment of frozen shoulder is usually restricted to pain control medication and exercises to restore normal shoulder range of motion. An alternative name for frozen shoulder is adhesive capsulitis.

The shoulder  comprises 3 main bones that together make up the joint in a ball and socket arrangement. These are the scapula, the humerus and the clavicle (see image to the left for an illustration). These 3 bones are held together by tissues that form a capsule (known as the shoulder capsule).

When frozen shoulder develops, the tissue forming the shoulder capsule becomes thick and tight and restricts movement of the joint. In addition, scar tissue develops in the shoulder capsule. There is also a decrease in the amount of synovial fluid in the joint (a fluid that acts to lubricate the joint and help it maintain its range of motion). These result of these developments is less range of motion and, after enough time, difficulty moving the shoulder at all without experiencing pain. These are the proximate causes of frozen shoulder problems.

What Are The Underlying Causes Of Frozen Shoulder?

Although the immediate cause of frozen shoulder is understood, the underlying causes are less clear in most cases. Doctors do know that it occurs more often in women than men and that those between ages 40 and 60 are most likely to experience it.

In addition, there appears to be a correlation between being in the recovery stages of certain conditions (e.g. stroke or mastectomy) and experiencing a frozen shoulder. Other medical conditions that seem to be associated with adhesive capsulitis are diabetes, heart disease, thyroid problems  and Parkinsons’ Disease.

Frozen Shoulder Symptoms

As mentioned above, the main symptoms of frozen shoulder are pain and stiffness in the joint that come on gradually over time and eventually reduce its range of motion. The pain is usually dull in nature and affects one shoulder only. In some case, it may extend as far as your upper arm and may also get worse at night. You may find that it even affects your ability to sleep properly.

Frozen shoulder symptoms normally have 3 distinct phases:

  • Freezing (6 to 9 months in duration) – you start to feel a pain in your shoulder whenever you try to move it. This pain gradually increases in severity over time. After a while, it may start to appear at night.;
  • Frozen (4 to 12 months in duration) – your pain may start to recede but you continue to lose range of motion. Shoulder stiffness may get to the point where it interferes with routine daily activities (like dressing, for example);
  • Thawing ( 6 months to 2 years in duration) – your range of motion starts to increase again. Over time, you eventually recover normal use of your shoulder.

Treatment

As we have mentioned earlier, this condition resolves by itself in most cases. As a result, treatment of frozen should usually mainly involves use of pain control medication and exercises to restore joint range of motion. Your doctor may start by suggesting use of over the counter medications like aspirin. The the pain is severe, non steroidal anti inflammatory medications are also an option.

In cases of severe discomfort, your doctor may raise more aggressive frozen shoulder treatments for your consideration:

  • Corticosteroidal injections to aggressively combat the pain. These have sometimes been especially successful in the early freezing stages of the condition;
  • Shoulder manipulation – your doctor will place you under general anesthetic and then manipulate your shoulder in an attempt to loosen the tissue of your shoulder capsule and increase your range of motion;
  • Another injection based treatment is to inject sterile water into the tissues of the shoulder capsule. The hope is that this will stretch these tissues and increase the room in the shoulder joint to move the shoulder;
  • Arthroscopic surgery to remove the scar tissue that may have developed around the shoulder capsule. This will help to create room for you to move your shoulder more easily.

Shoulder Exercises

To prevent or reduce the loss of range of motion due to a frozen shoulder, a physiotherapist can prescribe range of motion exercises. You can usually carry out many of these exercises at home using a shoulder pulley.

Shoulder exercises are an important component of the treatment program for frozen shoulder. The exercises can include (but not necessarily be limited to) the following:

  1. Shoulder flexion;
  2. Shoulder abduction;
  3. Internal rotation of the shoulder.

You may initially perform many of these exercises at home under the supervision of your physiotherapist. However, as mentioned, once you are familiar with the exercises, you can continue the program at home.

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