WHAT IS “FROZEN SHOULDER?”

Frozen shoulder or Adhesive Capsulitis (AC) describes a pain experienced when the shoulder moves. This pain gradually progresses to the point that it is difficult to even move the shoulder. For some reason, the fibrous “bag” that helps to hold the shoulder joint together begins to thicken and tighten, causing pain and limiting motion.  This might occur after surgery or an injury, but it is not always clear why it occurs. AC slowly gets worse until the shoulder becomes almost completely stiff, then over time it may loosen and return to normal. Most people suffering this pain will seek out healthcare providers to reduce severity of symptoms.

AC can occur insidiously and/or following a traumatic event that causes the patient to have limited motion in the shoulder for a prolonged period of time. When the condition occurs insidiously, it is considered “primary AC.” When the condition follows a traumatic event, it is referred to as “secondary AC.”  In either case, the symptoms are the same and the pain and loss of motion can be extremely debilitating.

Adhesive capsulitis involves inflammation and “adhesions” or scar tissue formation in the capsule of the shoulder joint.  The normal capsule is leather- like and provides static stability to the highly mobile shoulder joint, but when it develops the painful condition of a frozen shoulder there is less room for the humeral head to move which reduces the range of motion in the shoulder.  The anterior portion of the capsule and the ligaments in that area thicken.  When these structures thicken and shorten they become more inflamed every time they are stretched or pulled and this action causes a tremendous amount of sharp pain.

One cause of AC could be a result of poor posture.  If someone continually assumes a “rounded” shoulder posture they are more prone to developing AC due to a postural shortening of the entire anterior shoulder anatomy.  The chest wall musculature, anterior capsule, coracohumeral and middle glenohumeral ligaments can become thicker and shorten leading to less space for the humeral head to move.

Adhesive capsulitis occurs in three phases, freezing, frozen and thawing.  The freezing phase is the initial phase and its main characteristics are pain but no significant loss of motion.  It can occur in a few weeks or months.

The frozen phase is primarily when the joint gets “sticky” and the adhesions form.  These adhesions are extremely painful at most times unless the joint is held perfectly still.  This phase usually lasts approximately 7-9 months and the loss of motion can be severe.

The thawing phase can last 1-2 years.  The return to “normal” motion is extremely slow but the intensity of pain usually begins to reduce.  Some studies claim that this phase can last up to 10 years.

Diagnosis of AC is done via physical examination and MRI.  Normal, standard X-rays show nothing that will enable the healthcare professional to make a definitive diagnosis. Treatment of the condition includes many different protocols.  The primary goal is to reduce the pain and control the inflammation.  Maintaining motion needs to be done but being too aggressive in the early phases can actually hasten the progression.  There is no clear reason why this happens, but it is proposed that being mobilized and stretched too aggressively can cause more pain and inflammation which leads to a decrease in active motions.

If you suspect that you might be suffering from AC, seek the advice and treatment of a Physical Therapist.  These licensed healthcare professionals can evaluate you and devise a rehabilitation program that will help to reduce the symptoms and restore the motion and function of the involved shoulder joint. Scheduling a visit with a Physical Therapist does not require a doctor’s prescription but your insurance plan might require a referral from your general practitioner.

Adhesive capsulitis can limit motion to a point that the person suffering from the symptoms can lose a large portion of the functional use of the involved shoulder. Treating this condition by reducing pain, inflammation and restoring the motion within the shoulder joint is critical. The joint function will be restored when the symptoms are under control.