Injury of the Week - Frozen Shoulder (Adhesive Capsulitis)
Thursday, January 7, 2010 at 02:10PM ;)
Frozen shoulder is characterized by a severe restriction or limitation in the normal range of motion the shoulder is capable of. Movements such as bringing the arm out to the side, raising the arm, reaching around to the back and/or sleeping on the shoulder can become excruciating. There is a general feeling of stiffness and inability to move the shoulder or arm easily.
What causes Frozen Shoulder?
Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. The adhesions that form take up vital space in the shoulder joint restricting movement. Additionally, the synovial fluid that acts as a lubricant in the joint capsule dries up making movement extremely painful, tight and stiff.
Patients who have had a major shoulder injury and have experienced extended immobility due to pain, may begin to get early symptoms of frozen shoulder such as aching and general pain that is difficult to pinpoint in the shoulder joint.
Symptoms of Frozen Shoulder:
- Pain bringing arms out to the side
- Pain bringing arms behind your body
- Pain bringing arms overhead
- Pain when sleeping which often wakes you up
- Dull aching deep in the shoulder which can be difficult to pinpoint
- Stiffness and restricted movement of the shoulder
Who is at risk of getting Frozen Shoulder?
Frozen shoulder has an unknown cause of origin (idiopathic). Scientific researchers have not been able to determine exactly why it occurs. Affecting only 2-3% of the population, generally most patients are women between the ages of 40-60 years old. According to the American Academy of Orthopedic Surgeons, those most at risk are persons who have diabetes, arthritis, history of previous rotator cuff issues, hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac disease or surgery.
Diagnosis of Frozen Shoulder:
Persons experiencing frozen shoulder are encouraged to visit their local orthopedic doctor for diagnosis. The doctor will generally perform a physical examination to determine the full extent of limitation and may suggest an x-ray or MRI to confirm the diagnosis and/or rule out any other potential issues.
Stages of Frozen Shoulder:
Although the total time frame can be different for each person, the general stages are listed below:
- Stage 1: Inflammation/Pain (0-3 months). The lining of the joint (synovium) is inflamed. Moderately severe pain with gradual onset of aching over the shoulder joint.
- Stage 2: Freezing Stage (3-9 months ) Synovitis and scar formation in the underlying capsule. Severe pain.
- Stage 3: Frozen Stage (9-15 months). Minimal pain, increased stiffness due to scar formation in the joint capsule. Synovial fluid decreases, adhesions restrict movement.
- Stage 4: Thawing Stage (15-24 months). Little pain, movement increases. Spontaneous resolution occurs as adhesions subside and mobility returns.
Treatment:
A doctor will usually prescribe an anti-inflammatory medication of some kind. They may also recommend a corticosteroid injection to reduce inflammation locally.
Physical therapy is strongly recommended for supervised stretching and range of motion exercises. Ultrasound, the TENS unit (electrical stimulation), cold laser therapy and heat have also been found to temporarily relieve pain for many patients.
Massage for frozen shoulder is recommended in order to help release the surrounding rotator cuff muscles which have become stiff from chronic pain and inflammation around the capsule. In particular the subscapularis muscle should be released through the use of trigger point therapy, careful lengthening and stretching as recommended by Travell and Fritz. The compensating muscle groups of the neck, latissimus dorsi and hips should also be addressed through the course of treatment.
Persons experiencing severe pain and limited mobility as a result of frozen shoulder should consider receiving 2-3 massage sessions/wk for 4-6 weeks in addition to physical therapy in order to promote healing, minimize muscular compensation patterns and increase range of motion to the shoulder. With frozen shoulder, it is imperative work be received from experienced health professionals.
In severe cases the most aggressive treatment is surgery. Often frozen shoulder will eventually resolve itself spontaneously over time but in extreme circumstances a patient may wish to consider this option. As always, before undergoing surgery it is wise to seek multiple physicians’ opinions.
About the author:
Naomi Gonzalez is a nationally certified licensed massage practitioner specializing in sports and injury therapy and founder of Inspire Your Body Massage. A former Olympic therapist for the 2004 US Women's National Soccer Team, Naomi brings over 10 years experience working with athletes at all levels of training and discipline.
Resources:
- Fritz, Sandy, Sports & Exercise Massage 2005; 465
- Travell, Simons, Simons, Travell & Simons’ Myofascial Pain and Dysfunction, The Trigger Point Manual Volume 1; 2nd Ed 1999; 602-606
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