Frozen shoulder, also known as adhesive capsulitis, is characterized by tightening and contracture of the shoulder joint capsule and surrounding ligaments.¬† The inner lining of the shoulder joint called the synovium, and the surrounding muscles are also affected. ¬†In the majority of cases, pain and loss of motion occur without any specific injury.¬† Sometimes only a minor trivial incident, such as bumping the shoulder against a wall, can be recalled by the patient.
The true underlying pathology of frozen shoulder is not well-understood.¬†¬† Some reports show the lining of the shoulder joint becomes inflamed while other studies show a lack of inflammation.¬† Changes in blood flow and nerve sensitivity have also been found.¬† However, it is well known that the outer capsule of the joint shrinks and thickens leading to significant pain and loss of motion.
Who is most commonly affected?
Frozen shoulder affects between 2% to 5% of the population.¬† The disorder most commonly affects women between the ages of 40 and 65 years old.¬† It often occurs in both arms several years apart.¬† It is also more common in those with certain diseases such as diabetes and thyroid disorders.
Signs and Symptoms
Patients with frozen shoulder often have pain at rest which is worsened at night and with movement.¬† As the disorder progresses, the range of motion becomes more and more restricted.¬† Pain typically begins to subside during this time but function can remain extremely limited due to stiffness.¬† The inability to reach overhead and behind the back are hallmark signs.
The Course of Frozen Shoulder
Frozen shoulder progresses through stages over the course of 1 to 3 years.¬† The first stage, called the ‚ÄúFreezing Stage‚ÄĚ is characterized primarily by increasing pain with some loss of motion.¬† As the disorder progresses into the ‚ÄúFrozen Stage‚ÄĚ, pain begins to subside but significant stiffness is present.¬† During the ‚ÄúThawing Stage‚ÄĚ, pain continues to diminish and range of motion slowly improves.
Previously, it was believed that frozen shoulder would resolve on its own by waiting 12 to 18 months.¬† However, several studies show persistent loss of motion and limited function for up to 3 years.¬† Therefore, it is important to take an active approach in order to avoid a delayed recovery.¬† Three of the most common treatment options include physical therapy, corticosteroid injection, and manipulation under anesthesia.
Physical Therapy for Frozen Shoulder
Range of motion and stretching exercises can be an effective treatment option for people with frozen shoulder.¬† However, it is important that the exercise program matches the stage of the disorder.¬† Overly aggressive stretching performed in the ‚Äúfreezing stage‚ÄĚ can result in increased pain and delayed recovery.¬†¬† Exercise is carefully prescribed by the physical therapist in order to meet the individual’s goals.
Manual physical therapy can also be an effective treatment for people with frozen shoulder.¬† In particular, joint mobilization and passive stretching techniques are useful in the later stages when pain is minimal.¬† The effects of manual therapy are always enhanced when patients perform regular home exercises.
Injections can be particularly helpful during the early ‚Äúfreezing stages‚ÄĚ of frozen shoulder.¬† They can help reduce some of the acute pain which occurs at night and while at rest.¬† Research shows combining injections with 4 to 6 weeks of daily home stretching can significantly improve pain and function.¬† Caution should be used for those with diabetes, as steroid injections can acutely influence blood sugar levels.¬† You can discuss this with your doctor to determine the best course of action.
Manipulation under Anesthesia
Manipulation of the shoulder joint by a physician while under anesthesia may be considered in cases where stiffness is not resolving.¬† This is often used during the later stages of frozen shoulder.¬† There may be some short-term increase in pain for several days.¬† However, when combined with regular home exercise and supervised physical therapy, manipulation under anesthesia can be very effective for improving function.
Frozen shoulder can be very frustrating for people because of the prolonged recovery.¬† However, there are effective treatments which can reduce pain, disability, and in some cases speed up recovery.¬† If you are suffering from frozen shoulder, discuss these treatment options with your physician.¬† In upcoming articles, we will go into more detail about physical therapy‚Äôs role in your recovery.