Should you have the misfortune to be diagnosed with a condition of ‘frozen shoulder syndrome’ you should be aware that this name is slightly erroneous. The shoulder is not ‘frozen’ and the ‘syndrome’ it refers to is a collection of symptoms that follow a particular clinical pattern. The ‘shoulder’ bit is actually correct
The more accurate clinic diagnosis is ‘adhesive capsulitis’.
Medical semantics aside what is this shoulder condition? what can the patient expect with this diagnosis? More importantly what can be done for what can be particularly debilitating and very painful presentation?This collection of symptoms mentioned above include, pain (constant, variable worse at night and occasional with cold weather), inflammation and variable loss of movement in the fibrous capsule surrounding the (shoulder) gleno-humeral joints.
Certain movements, sleeping positions and/or bumps can provoke episodes of tremendous pain. These are also associated with muscle spasm and cramping.
Causes of frozen shoulder syndrome
Various medical opinions point to trauma-related (whiplash is a classic example) and following a period of immobility. Mostly the condition has an idiopathic or insidious onset with no known incident.
At 5 Valleys Physio there is clinical consensus that it is a combined issue of age and postural demands on the upper trunk, neck and shoulders. With a good investigation history, a seemingly innocuous cause is usually unearthed
The syndrome is more frequent in diabetic patients and is more severe and more protracted than in the non-diabetic population. People with diabetes, stroke, lung disease, rheumatoid arthritis, or heart disease experience a higher risk of frozen shoulder.
Injury or surgery to the shoulder or arm may cause the capsule to tighten from reduced use of the limb during recovery.
Signs & Symptoms of frozen shoulder syndrome
Symptoms very much dependent on three loosely identified stages:
- Stage one: pain > stiffness: six weeks to nine months – slow onset of pain and associated pain related loss of movement and /or adaptive movement patterns
- Stage two: adhesive stage: pain subsides; stiffness = pain or stiffness > pain; four to nine months.
- Stage three: recovery: shoulder motion slowly returns to normal (?) – five to 26 months (depending on literature)
Secondary symptoms include depression, associated neck and back issues and weight gain due to long-term lack of activity. Similarly normal working and daily activities are affected. All of the above pretty much related to the debilitating nature and sheer discomfort of the condition.
The condition tends to be self-limiting will and usually resolves over time (up to 3 years) without surgery. Most people regain about 90% of shoulder motion over time.
Patterns in populations
The incidence of adhesive capsulitis is approximately 3 percent in the general population. Occurrence is rare in children and people under 40 but peaks between 40 and 70 years of age.
At least in its idiopathic form, the condition is much more common in women than in men (70% of patients are women aged 40–60).
What’s happening in the shoulder?
There is evidence of diminished fluid inside the shoulder joint. This leads to the joint capsule becoming thickened, swollen and tight. The joint capsule is a thick fibrous capsule that surrounds the upper arm as it sits inside the shoulder joint. This is due to development of bands of scar tissue (adhesions) that have formed inside the joint. This reduces the joint space for the arm bone (humerus) to move inside the shoulder joint.
This restricted joint space between the capsule and humeral head distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder.
How can manual therapy help?
Let’s look at each stage and associate the therapy to that particular stage
Stage one: pain > stiffness
Pain management is crucial in this early stage. Your therapist may recommend discussing suitable pain management with your local GP/ Nurse Practitioner. This includes the possible use of cortico-steroids, a particular effective treatment pathway.
Stage two: adhesive stage
Pain subsides; stiffness = pain or stiffness > pain; four to nine months. This is the stage that manual therapy will make its biggest contribution. It addresses joint stiffness and associated muscle tightness that is evident with this type of presentation. A specific home exercise program is initiated at this point. Strength and conditioning sessions are also recommended. These would drive home the benefits of good stability and re-training in rehabilitation. (there’s no point in gaining joint movement and then being unable to maintain it!)
Stage three: recovery
Shoulder motion slowly returns to normal. The time frame is between five to 26 months; manual therapy will be pretty much along the same lines as Stage two.
So, all is not lost… with good pain management and specific follow-up physiotherapy (which we obviously deliver at 5 Valleys!) a ‘frozen shoulder’ is a very manageable condition and the prognosis nearly always favourable.