What Is Frozen Shoulder (And Do You Treat It)?
The shoulder is a complex joint with one of the largest ranges of movement of all joints in the body. Because of this range of movement and the large amount of work that the shoulders are forced to do each day, shoulder pain and injuries can be quite common.
One of the less common, and more enigmatic, shoulder problems is adhesive capsulitis, also known as frozen shoulder. Generally recognised as an inflammation of the shoulder joint, the condition is characterised by pain and stiffness in the shoulder, making it difficult to move the arm.
Frozen shoulder typically develops slowly over a period of months, and the symptoms may last for years. While the exact cause of frozen shoulder is unknown, the condition can often be linked to a previous injury or surgery. Treatment for frozen shoulder typically includes physical therapy and exercise. In some cases, corticosteroid injections or surgery may be necessary.
Anatomy of the Condition
The shoulder is a ball-and-socket joint with three bones making up the joint: the humerus (or upper arm bone), the scapula (or shoulder blade), and the clavicle (or collarbone). The joint is surrounded by strong connective tissue known as the shoulder capsule. Within the capsule, the entire joint is lubricated by the synovial fluid.
Frozen shoulder involves a thickening and tightening of the shoulder capsule. Bands of scar tissue, also known as adhesions, can start to form and in many cases there is less synovial fluid present to help the shoulder move.
The main symptoms of frozen shoulder are a dull aching pain, stiffness and a limited range of motion in the shoulder joint. In extreme cases, it can get to the point where you can barely lift your shoulder. The pain usually presents in the shoulder muscles around the top of your arm, but can also radiate through the upper arm.
Since the pain can become worse (or at least more noticeable) at night, frozen shoulder can also disrupt your sleep.
Frozen shoulder can often come on slowly and present in three stages, with each stage lasting up to several months. First comes the freezing stage, when you start to notice pain when making some shoulder movements, and your range of movement can become reduced.
Next comes the frozen stage. At this stage, the pain can often lessen but stiffness will increase, and the range of motion will remain constrained.
Finally, there’s the thawing stage where the range of motion gradually returns and the pain dissipates.
Left untreated, the whole process can take years to complete.
Causes & Risk Factors
The underlying causes of frozen shoulder are not fully understood. There is no evidence connecting it to arm dominance, occupation or repetitive movement.
There are, however, a few factors that seem to heighten the chances of developing frozen shoulder.
- Age and sex
In general, it’s women over the age of 40 who are most likely to develop frozen shoulder.
- Immobilisation or injury
Prolonged shoulder immobility can increase the chance of developing frozen shoulder. This is often seen in people recovering from shoulder injuries or surgery or conditions that affect shoulder mobility like stroke or arthritis.
- Other diseases
Frozen shoulder can also be associated with other medical issues including diabetes, hypothyroidism and hyperthyroidism, cardiovascular disease and Parkinson’s disease.
Treatments for Frozen Shoulder
Even without treatment, frozen shoulder will naturally get better over time. However, this process can take several years and, in the meantime, patients can experience pain, stiffness, and a severely reduced range of motion.
In general, treatment is focsued on relieving pain and restoring strength and the natural range of motion as quickly as possible.
Non-surgical treatments include the use of non-steroidal anti-inflammatory medicines like ibuprofen to manage the pain. Steroid injections like cortisone may also be used to reduce inflammation in the shoulder capsule.
The other primary for of treatment is physical therapy. Physical therapists or complementary health practitioners will provide a series of stretches and movements designed to strengthen the joint and increase the range of motion.
Alternative therapies like Bowen therapy, acupressure and remedial massage are also commonly used to increase movement, reduce inflammation and help to manage the symptoms associated with frozen shoulder.