Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder without actual damage to bone or muscles. Over time, the shoulder becomes very hard to move. Frozen shoulder occurs in about 3% of the general population and is 5 times more common in diabetics. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. There are two types of the condition: primary or idiopathic and secondary. Primary frozen shoulder occurs without a known reason, whereas secondary frozen shoulder may be the result of immobilization after an injury, a shoulder fracture or a neurological damage such as a stroke.
The shoulder complex composed of 4 joints. Each joint has to work properly in order for the whole complex to be intact.
The joint between the arm and the scapula—glenohumeral joint
The joint between the collarbone and the tip of the scapula (acromion)—acromioclavicular joint
The joint between the collarbone and the sternum—sternoclavicular joint
The joint between the scapula and the ribs—scapulothoracic joint
The glenohumeral joint is surrounded by a strong connective tissue called the shoulder capsule. Within the capsule there is a synovial fluid that lubricates the shoulder capsule and the ligaments and tendons inside.
Left side a healthy shoulder Right side a frozen shoulder
In frozen shoulder, the shoulder capsule thickens and becomes tight. Stiff bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.
The hallmark sign of this condition is being unable to move your shoulder - either on your own or with the help of someone else. It develops in three stages:
Freezing--In the "freezing" stage, you slowly have more and more pain even after PT treatment. As the pain worsens, your shoulder loses range of motion especially during hand behind head, behind back and to the side. Freezing typically lasts from 2 to 9 months.
Frozen--Painful symptoms may actually improve during this stage, but the stiffness remains. Pain will show up at end ranges. During the 4 to 6 months of the "frozen" stage, daily activities may be very difficult.
Thawing--Shoulder motion slowly improves during the "thawing" stage. Pain is improving significantly and daily activities are easier to complete. The thawing stage lasts 1-9 months more.
These stages are typical to primary frozen shoulder, in which reasons are unknown. In secondary frozen shoulder, where symptoms may develop following an accident or a fracture, the stages may be shorter with better and quicker outcomes.
The reasons for developing frozen shoulder are unknown, but there are several risk factors:
Immobilization--frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.
Age— the syndrome most commonly affects people between the ages of 40 and 60
Diabetes--frozen shoulder occurs much more often in people with diabetes, affecting around 20% of these individuals.
Heart and lung diseases—conditions such as TB, emphysema, lung cancer and IHD, all of which include prolonged hospitalization, have higher risk for frozen shoulder.
Treatment for frozen shoulder is usually conservative and depends on the current stage of the patient. Clinical experience treating primary frozen shoulder shows limited success for PT in the freezing stage; however, strong evidence exists for the advantages of PT in both the frozen and the thawing stages. In case PT does not help, surgical intervention are taken under consideration. Procedures such as manipulation under anesthesia or orthoscopic surgery can be performed to release the stubborn shoulder tissues.
In the case of secondary frozen shoulder, the best way to treat is by prevention. Early mobilization after an injury is vital to minimize the chances to develop frozen shoulder.
If you feel unsure or unable to perform what is needed, seek professional help soon!