Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a result of a chronic inflammatory process that results in capsular (shoulder joint) contraction. It affects 2-5% of the general population. It is characterized by pain, stiffness, and loss of motion in the shoulder joint. The condition develops gradually and typically progresses through three stages named freezing, frozen, and thawing. Anyone who has experienced frozen shoulder will know it is a debilitating, painful condition that can take months or years to resolve. It is more likely to involve the non-dominant shoulder but can involve both! Thankfully not usually at the same time.
It was defined by Grubbs (1993) as “a soft tissue capsular lesion accompanied by painful and restricted active and passive motion at the glenohumeral joint”
It is thought to be a protective mechanism by the body as a result of injury, to immobilise the shoulder by creating layers of fibres in the shoulder joint. Treatment then involves manual therapy to reduce pain, increase range of motion and eventually break down these fibres to return to normal shoulder function once again. Manual therapy initially aims to create an inflammatory response to engage the bodies innate healing ability.
The exact cause of frozen shoulder is still not fully known, but the following risk factors may contribute to its development:
Age and sex: frozen shoulder affects mostly women (60:40) between the ages of 40 and 60. In Japan it is known as ‘fifties shoulder’.
Immobilization: prolonged immobilization of the shoulder due to injury, surgery, or other medical conditions.
Systemic diseases: conditions like diabetes, thyroid disorders, cardiovascular disease, and Parkinson's disease are associated with a higher incidence of frozen shoulder.
Previous shoulder injury: people who have experienced a shoulder injury or trauma may be more prone to developing frozen shoulder.
The symptoms of frozen shoulder usually begin gradually and worsen over time. They typically include:
Shoulder pain: the pain is usually dull and aching, and it may worsen with movement or at night which characterises the frozen stage.
Stiffness: the shoulder becomes progressively stiff, limiting the range of motion. Activities like reaching overhead, putting on clothes, or combing hair become challenging.
Loss of shoulder function: as the condition progresses, the shoulder may lose significant motion, making it difficult to perform everyday tasks.
It is thought to be a protective mechanism by the body as a result of injury, to immobilise the shoulder by creating layers of fibres in the shoulder joint. Treatment then involves manual therapy to reduce pain, increase range of motion and eventually break down these fibres to return to normal shoulder function once again. Manual therapy initially aims to create an inflammatory response to engage the body’s innate healing ability.
Treatment may include the following:
Physical therapy: gentle stretching and range-of-motion exercises prescribed by a physical therapist to help improve shoulder mobility.
Pain relief: nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, or other pain medications may be recommended to reduce pain and inflammation.
Hot and cold therapy: applying hot or cold packs to the shoulder can help reduce pain and improve flexibility. An anti-inflammatory cream such as Fisiocrem may also help.
Joint distension: in some cases, the doctor may inject sterile water into the joint capsule to stretch and expand it, providing relief. A normal shoulder joint has between 60-70ml of free synovial fluid within the capsule, in a frozen shoulder this may reduce to as little as 5ml.
Surgical intervention: In severe cases where these measures are unsuccessful, arthroscopic surgery may be considered to remove scar tissue and adhesions.
It is hoped that by undergoing regular massage treatments surgery can be avoided although recovery from frozen shoulder can be a lengthy process, taking several months to possibly years. Physical and manual therapy, home exercises, and adherence to the recommended treatment plan are crucial to restore shoulder function
I have undertaken further study outside of my Remedial Diploma to help with this condition. The treatment involves a specific protocol and series of techniques involving massage catered to pain levels, releasing specific shoulder trigger points and encouraging an increase in range of motion of the shoulder. Range of motion is measured at each visit to identify progress. This treatment gives the possibility of significantly reducing recovery times.
It's important to consult with a healthcare professional, such as a doctor or physical therapist, for an accurate diagnosis if you suspect you may have frozen shoulder.