You wake up one morning with pain in your shoulder but don’t remember injuring it. You hope it will go away but weeks later the pain is still there. Then, just when you decide to go to the doctor, the pain just disappears. Now you realise you can’t lift your arm above your head. No pain, but it just won’t move. As the days pass you’re able to move your arm less and less. Sounds familiar? You may have what is commonly known as frozen shoulder. Its technical name is Adhesive Capsulitis (AC).
The shoulder joint is formed by three bones: the humerus (upper arm), the scapula (shoulder blade) and the clavicle (collar bone). It is built for mobility rather than stability and this is reflected in the fact that the stability of the joint is provided by muscles and a joint capsule instead of a deep socket, as in the hip. It is the thickening and tightening of the capsule that is responsible for the freezing (reduced movement) in the shoulder.
The exact cause of AC is unknown but is thought to begin with injury or trauma to the area, or in some cases related to the autoimmune system. It is also known to develop as a secondary problem if the shoulder is immobilised because of an injury or fracture. As the disease progresses, the capsule that surrounds the shoulder joint can become inflamed and in response becomes tight, causing stiffness and reduced movement.
Although the cause is unknown, there are factors that increase the risk of developing this painful and debilitating condition. As well as injuries and conditions that cause decreased movement of the arm—for example fracture, stroke and rotator cuff injuries—systemic diseases such as diabetes, thyroid disease, heart disease and Parkinson’s disease also increase the risk of developing AC. Another risk factor that has been noted is gender and age; it is more common in women and people over forty.
The symptoms appear gradually, and from onset to recovery can take anywhere from a year to three years. Despite this gradual onset of symptoms, there are three distinct stages: Freezing -The first noticeable symptom is pain in the shoulder which may spread to the top of the arm. This stage usually lasts for six to nine months and, as the pain worsens, sleeping at night may become difficult.
Frozen – During this stage the pain may disappear but movement of the shoulder is restricted and feels frozen, making simple tasks like getting dressed extremely difficult. This stage can last anywhere between four and twelve months.
Recovery – Also known as the thawing stage. Gradually movement returns and your range increases but this can take between six months and two years. Diagnosis by your healthcare provider can usually be confirmed by performing certain movements actively and passively. If it is a muscular problem, you may be unable to actively perform the movement, due to pain and weakness, but may have less pain and more range if your arm is moved passively.
However, in cases of frozen shoulder, both active and passive movement will be restricted due to tightness in the capsule. It is not usually necessary to have an x-ray or an MRI but they can be used to rule out other conditions or pathology like arthritis or rotator cuff tears. Once a diagnosis has been reached then treatment options need to be considered. In many cases this condition resolves spontaneously but there are steps that can be taken to relieve the symptoms of each stage.
Self-care is the most important element of your home recovery. A daily routine of ice, stretching and exercise is important to try and minimise the progression of the condition. If your symptoms are not relieving, your doctor may prescribe an anti-inflammatory medication for pain and inflammation and in extreme cases might suggest a steroid injection into the shoulder. In cases where the symptoms are severe and recovery is slow, your doctor may suggest surgery to remove scar tissue and release the tension in the capsule, increasing the range at the shoulder.
However, before you opt for surgery, physiotherapy can help relieve pain and increase movement. Depending on the stage of the condition, your physiotherapist has a range of skills and techniques they can use to speed up your recovery. If pain is the main issue, they may use electrotherapy or acupuncture. If reduced range and function is a problem then they may use a combination of massage, mobilisations and exercises to help stretch and strengthen the capsule and muscles around the shoulder. The results are not always instant but this, coupled with a home exercise programme, could help to speed up the recovery process.