Frozen Shoulder (Adhesive Capsulitis of Shoulder)
Frozen shoulder, also referred to as adhesive capsulitis of shoulder, occurs when the connective tissue surrounding the glenohumeral joint becomes swollen and stiff. This inflammation restricts mobility and can result in chronic pain. This pain is often worse at night and when the weather is cold. This injury can often occur as a result of a minor injury or without any warning.
Recovery from this condition is slow and can be frustrating.
The glenohumeral joint, a ball and socket joint, (also referred to as the shoulder joint) is supported by four muscles: the subscapularis, the supraspinatus, the infraspinatus and the teres minor. All of these muscles encompass this joint and help to control the joint during rotation.
The glenohumeral joint is where the humerus (bone in upper arm) attaches to the scapula (shoulder blade). This joint usually has good mobility and flexibility. In a frozen shoulder the lining of the shoulder, referred to as the shoulder capsule, swells and tightens because of a build-up of scar tissue, making movement difficult and painful.
Frozen shoulder is more typical in 40 to 60 years old and women. It rarely occurs in people under 40 and affects 1 in 50 people. It is not a common injury in sport. It is more common in diabetics.
Frozen shoulder often occurs in the non-dominant shoulder. If you are right handed it would be your left shoulder.
- An injury can lead to the loss of use of the shoulder through pain (immobilisation). This can result in a frozen shoulder as the shoulder stiffens up through loss of use. This may be the case post sports injury.
- Shoulder surgery or a breast mastectomy might lead to a frozen shoulder.
- Fracture of the collar bone or humerus.
- Rotator cuff impingement syndrome
To test for a frozen shoulder ask the patient to raise their arm to a horizontal level. If they have a frozen shoulder they can only raise their arm slightly.
Other symptoms include:
There are 3 stages of frozen shoulder:
- Painful, particularly at night and when cold
Stage 1 (2-9 months)
It will ache and start to feel stiff. It is worse at night, especially when sleeping on the injured side. Movement becomes impaired.
Stage 2 (4-12 months)
This stage is referred to as the adhesive phase.
The shoulder increases in stiffness, but the pain remains the same.
The shoulder muscles begin to waste (muscle atrophy). Movement is limited.
Stage 3 (recovery) (5 months -3/4 years)
This is the recovery phase. Movement starts to return and the pain decreases. As the stiffness eases the occasional twinge of pain can be felt.
Recovery from a frozen shoulder can be slow but the prognosis is usually good and patients make a full recovery. Initially every day activities might be difficult, such as dressing, and driving.
It is important not to ignore this condition and to seek medical advice to ensure the most effective treatment.
It is important to avoid activities that make the pain worse, but it is important that some movement is still maintained, as inactivity makes the situation worse.
Ice can help ease pain and inflammation. For the first 48-72 hours, ice packs can be administered for 10-15 minutes, every 2-3 hours.
Ice treatment can be continued through the sub- acute stage (3 days-3 weeks), frequency can be reduced according to recovery, and can be continued for as long as deemed necessary.
In the sub-acute stage (3 days – 3 weeks) heat therapy can be applied.
NSAIDS (anti-inflammatories} or paracetamol may be necessary. Medical advice should be sought first before administering (in case of possible side effects).
In certain cases doctors might advise Steroid Injections to ease the pain.
Manipulation is performed if the pain and discomfort is becoming unbearable. Manipulation is performed under general anaesthetic. The shoulder is lightly stretched and moved.
Physiotherapy can help by giving flexibility and strengthening exercises in the sub-acute and chronic stage of healing. It is important to keep using the shoulder and performing gentle mobility exercises (circular rotations).
Sports massage can also help aid repair in the sub-acute and chronic stage, by improving circulating, breaking down scar tissue, and improving mobility. Massage should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
Sophia Cross, BA (Hons) MA