Frozen shoulder, also called adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed. The joint capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint. Meaning it causes pain and stiffness in the shoulder.
Over time, the shoulder becomes very hard to move. Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.
In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems sleeping for extended periods due to pain that is worse at night and restricted movement/positions. The condition also can lead to depression, pain, and problems in the neck and back.
Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, when the weather is colder, and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.
It can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.
Causes:
Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Any injury to the shoulder can lead to frozen shoulder, including tendinitis, bursitis, and rotator cuff injury.
Frozen shoulders occur more frequently in patients with diabetes, chronic inflammatory arthritis of the shoulder, stroke, lung disease, connective tissue disorders, heart disease or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder. The condition very rarely appears in people under 40.
Doctors aren't sure why this happens to some people and not to others, although it's more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture. Because of the high incidence of frozen shoulder in people with diabetes, there may be an autoimmune basis to the disease.
Symptoms:
Frozen shoulder without any known cause starts with pain. Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm. This pain prevents you from moving your arm. The lack of movement leads to stiffness and then even less motion. Over time, you become unable to perform activities such as reaching over your head or behind you. The movement that is most severely inhibited is external rotation of the shoulder. For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.
Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.
- Freezing stage: During this stage, pain occurs with any movement of your shoulder, and your shoulder's range of motion starts to become limited. In this stage, you slowly have more and more pain. Freezing typically lasts from 6 weeks to 9 months.
- Frozen stage: Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably. During the 4 to 6 months of this stage, daily activities may be very difficult.
- Thawing stage: During the thawing stage, the range of motion in your shoulder begins to improve. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.
Treatment/Management:
The treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injection(s) into the shoulder, and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.
Diligent physical therapy is often key and can include ultrasound, electric stimulation, range-of-motion exercise maneuvers, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.
Medications:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications may help relieve pain and inflammation associated with frozen shoulder. Acetaminophen (Tylenol, others) also may be effective for pain relief.
- Corticosteroids. Injecting these anti-inflammatory medications into your shoulder joint may help decrease pain and shorten symptom duration during the initial painful phase. Repeated corticosteroid injections aren't recommended.
Alternative medicine treatments include:
- Acupuncture for pain management and greater range of movement
- Nutrition
- Osteopathy
- Chiropractic
- Water therapies, such as exercises in water, jacuzzi
- Homeopathy: A medicine called Rhustox 30 is used to treat a frozen shoulder along with other complaints relating to joints.
Surgical and other procedures:
- Distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
- Shoulder manipulation. In this procedure, you're given general anesthesia and then the doctor moves your shoulder joint in ways that help loosen the tightened tissue.
- Surgery. In a small number of cases, especially if your symptoms don't improve despite other measures, surgery may be an option to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with a lighted, tubular instrument inserted through a small incision in your joint.
Therapy:
- A physical therapist can teach you exercises to help maintain as much mobility in your shoulder as possible, without stressing your shoulder to the point of causing a lot of pain.
- Frozen shoulder generally gets better over time, although it may take up to 3 years. The focus of treatment is to control pain and restore motion and strength through physical therapy.
How Can Massage Therapy Help with Frozen Shoulder?:
Massage therapy is a helpful treatment for frozen shoulder because it increases blood flow to the injured area and helps to reduce scar tissue. Regular massage treatments are needed to reduce muscle stiffness, and you may not start to feel relief until after several massage treatments.
A combination of techniques, performed by an experienced massage therapist, will provide shoulder pain relief and help your recovery during the “thawing,” or recovery stage of the condition. Deep-tissue massage is a common technique used to treat frozen shoulder. With this technique, the therapist applies steady pressure to the muscles to release adhesions or scar tissue that may be contributing to shoulder pain. A Japanese form of deep-tissue massage, called shiatsu, involves deep pressure on specific areas of the body, called acupressure points, to adjust energy flow (“Ki” in Japanese) through the body, thereby reducing pain. Deep-tissue massage techniques should be avoided during times of acute shoulder pain, inflammation, or swelling.
Other massage techniques for frozen shoulder include trigger point therapy, in which steady pressure is applied to targeted points within muscles to relieve muscle spasms, and Swedish massage, which involves gentle kneading and long strokes applied to surface muscle tissues to reduce stress and tension.
Heat therapy, applied immediately before or after massage, is also very beneficial in treating frozen shoulder.
Stretches you can do to help Frozen Shoulder:
External rotation — passive stretch.
Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.
Forward flexion — supine position.
Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.
Crossover arm stretch — assisted stretch.
Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.
