"Frozen Shoulder" is the common name for "adhesive capsulitis," a chronic and debilitating condition affecting mostly, but not exclusively, women.
Frozen shoulder describes a shoulder which has become so stiff that the patient can no longer raise their his or her arm above shoulder level. Women can no longer fasten their bra in back while men have difficulty tucking in their shirts and reaching their wallet out of their back pocket. It's hard to reach across your body to scrub under the opposite arm and combing your hair or putting the glasses away on the upper shelf has become impossible.
Shoulder immobility can be caused by any number of problems. You injured your shoulder working in the yard last summer and quit trying to move it through painful range. Over time you have lost the ability to move the arm, but you just can't bring yourself to go to the doctor. Maybe you've noticed that your joints are generally stiffer than they used to be and it takes so much effort to raise your arms, it's just not worth it.
Undiagnosed rotator cuff injuries and arthritic changes certainly contribute to shoulder stiffness and it is not unusual for folks who have recently had shoulder surgery to develop a "capsular pattern" of immobility which requires another procedure by the doctor to restore mobility in the joint. A true frozen shoulder is different.
We do not know what causes frozen shoulder. Women seem to be more prone to developing frozen shoulder, which may indicate a hormonal connection, but men get the disease as well. Some patients report pain beginning with overuse, like window washing during spring cleaning, but this is not always the case. It certainly does not appear to be caused by a virus nor is it contagious. Folks with diabetes seem much more prone than others to getting it, but the diabetes itself does not cause the problem. Frozen shoulder is not related to any particular work task and is not the result of either manual or repetitive work.
Frozen shoulder generally affects the middle aged and elderly and can be measured in three phases: freezing, frozen, thawing. During the freezing phase, blood vessels are growing like crazy and lining the delicate tissue that surrounds the shoulder joint. This is the most painful phase and, although pain fluctuates during the day, it is often worst at night making it nearly impossible to get a good night's sleep. Most people complain of pain over the front of their shoulder traveling down the biceps tendon in the front of the arm or down the side of the arm toward the elbow.
During the early inflammatory stage, treatment is directed at reducing the inflammation and relieving the pain. Aggressive treatment, trying to force the shoulder to move through painful ranges, can actually make things worse. Corticosterioid injections may or may not give some relief. Frequent ice applications can help reduce the pain as can hot or icy rubs. While it is important to keep the shoulder moving through ranges that are not painful, try to avoid anything that increases your pain.
About eight months into the process, the shoulder is frozen. This stage is less painful, but the joint keeps getting stiffer and stiffer. Pain is usually at the end of your range. You are able to find comfortable positions and you are getting more sleep. It is during this stage, and the next, that your physical therapist comes into play. While your therapist should be careful not to stir up the inflammatory phase again, mobilization and exercise can help to increase your range and strengthen the arm in the range you have available.
Finally, the thaw. Inflammation is gone and there is very little pain. Unfortunately, the scar tissue that formed during the inflammatory phase is mature now and the shoulder is still very stiff. Hopefully you started physical therapy sometime during the frozen phase and it will continue during this time. Eventually, you will finish your physical therapy, but it is very important that you continue your exercises at home.
Frozen shoulder is a highly variable disease, resolving quickly in some, but really dragging out for others. One person might work their way through all three stages in as little as 12 months while other folks will struggle with it for two to three years. Many people experience a permanent loss of motion although the pain generally resolves completely.
Frozen shoulder does not tend to recur in the same shoulder already affected, but folks who have one frozen shoulder have about a 30 percent chance of having a similar problem in the other shoulder. You should make an effort to keep your shoulders strong and limber, but there is no guarantee that you will not develop frozen shoulder.
Frozen shoulder is a mysterious and frustrating condition, but by understanding the disease process you can work with it instead of against. The appropriate treatment during the appropriate phase can help limit your symptoms and help you regain as much motion as possible.
About the writer: Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com
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