A stiff and painful shoulder is a very common problem in sports medicine clinics
A frozen shoulder is a common problem that is difficult to treat…
Adhesive capsulitis or frozen shoulder is a common, poorly understood condition. This condition is most prevalent in women between the ages of 40 and 60. It tends to begin with the insidious onset of shoulder discomfort and stiffness. The stiffness progresses over a series of weeks, and can become quite significant. Patients will often have difficulty performing activities of daily living such as washing their hair or other grooming activities.
The shoulder pain is most pronounced when an individual uses their arm to reach for an object above their head or to the side. The pain from these sudden movements can be very intense and last for several minutes. The baseline pain is often bad at night when individuals sleep on their sides.
The cause of adhesive capsulitis is not known. The capsule or tough lining of the shoulder joint seems to shrink, particularly in a fold close to the armpit known as the axillary fold. This condition is referred to as frozen shoulder as there is very poor range of motion of the shoulder. It tends to follow a pattern much akin to a Winnipeg winter. There is a gradual process of freezing, where the shoulder develops more and more stiffness. The stiffness or frozen phase will last several months and then there is a gradual thawing process. In general, this can take place over 6 to 18 months (again, like a Winnipeg winter). In the frozen phase, patients don’t have so much pain, but very much stiffness.
The pattern of stiffness found in adhesive capsulitis is a major clue to the diagnosis. Most shoulder problems cause a limitation in the plane of movement known as internal rotation. This is the movement you make when you try to scratch your back from the lower back up to the shoulder blades. Women often make this move when they fasten their bras. In adhesive capsultis this movement is quite limited. However, patients will also be unable to elevate their arm above their shoulder in forward flexion, or out to the side. This type of stiffness can be found in other shoulder conditions like rotator cuff disease. The diagnostic loss of range of motion in adhesive capsulitis is in external rotation, where the arm moves away from the midline of the body. The plane of movement is only limited in adhesive capsulitis and degenerative change of the ball and socket joint, known as glenohumeral arthrosis.
The medical literature does not establish a proven treatment for this condition. Individuals should try to work through range of motion in a gentle fashion. Sharp, intense or aggressive mobilization techniques will be met with much pain, resistance, and flare the condition. I encourage patients to develop a peaceful co-existence with the frozen shoulder, not bugging it, so it won’t bug the patient.
Injections into the subacromial space or the gleno-humeral joint can be done to help night pain. Techniques involving more aggressive interventions such as manipulating the shoulder while the patient is anesthetized or surgical debridement, in general, do not have support in the literature. Modern techniques such as trying to distend the shoulder capsule under ultrasound guidance show promise, but have yet to be validated in the literature.
Using a pulley system or a stick to keep mobility and prevent further loss of range of motion are required. Patients often derive symptomatic benefit from massage to the tight and irritated muscles around the shoulder girdle. Unfortunately, there is no guaranteed technique to restore range of motion until the condition decides it is time to thaw.
Adhesive capsulitis is like a Winnipeg winter…it lasts up to 18 months and makes movement difficult…..
The prognosis for frozen shoulder is quite favorable and most patients will be left without a significant impairment. When you are suffering with a frozen shoulder, this seems impossible as there is so much stiffness and discomfort that you think the shoulder will never be the same again. It is reassuring to examine these patients after time and see that they have basically regained all shoulder range of motion and their pain has dissipated.
Peaceful co-existence is a good mindset to approach your frozen shoulder…don’t bug it and it won’t bug you.