Frozen shoulder, also known as Adhesive Capsulitis, is a common complaint encountered by doctors and physical therapists, in which the shoulder joint capsule becomes thickened and inflamed. There is also restriction of the capsule as it stiffens and adheres to the articular surface. It causes restricted range of movement in the shoulder joint and pain. It typically affects only one shoulder, but one in five cases affect both.
It affects females slightly more than males, typically between 40 and 60 years, usually the non-dominant arm. Adhesive capsulitis affects 2–5% of the population, more in diabetics (10–20%) and in patients with coronary heart disease. Other factors such as depression, immunologic factors, posture and occupation have been implicated in the cause.
What causes frozen shoulder?
The causes are not fully understood. However the incidence is more common in patients who have experienced a recent trauma or fracture. It is also more common in people with diabetes, coronary heart disease, depression, immunological disorders and poor posture.
Age – being over 40 years of age.
Gender – 70% of people with frozen shoulder are women.
Recent surgery or arm fracture – immobility of recovery may cause the shoulder capsule to stiffen.
Diabetes – two to four times more likely to develop frozen shoulder for unknown reasons. Symptoms may be more severe.
History of strokes.
Signs and Symptoms
Signs and symptoms of frozen shoulder develop gradually; usually in three stages in which signs and symptoms worsen gradually and resolve within a two – year period.
There are three stages of frozen shoulder:
Painful stage – the shoulder becomes stiff and then very painful with movement. Movement becomes limited. Pain typically worsens at night.
Frozen/adhesive stage – the shoulder becomes increasingly stiff, severely limiting range of motion. Pain may not diminish, but it does not usually worsen.
Thawing stage – movement in the shoulder begins to improve. Pain may fade, but occasionally recur.
Diagnosis of frozen shoulder is based on signs and symptoms and a physical exam; paying close attention to the arms and shoulders. The severity of frozen shoulder is determined by a basic test whereby certain parts of the arm and shoulder are palpated and different ranges of movement are assessed.
What are the treatment options for frozen shoulder?
Osteopathic treatment focuses on pain relief and preservation of mobility and flexibility, without straining the shoulder or causing too much pain.
A treatment plan requires patient compliance and patience as it can take a few months to get better. Clinical experience suggests the rate of recovery is accelerated with manual treatment.
Other treatment options for frozen shoulder include:
Painkillers – relieve symptoms of pain. Nonsteroidal anti – inflammatory drugs (NSAIDs), such as ibuprofen, are over – the – counter (OTC, no prescription required) painkillers and may reduce inflammation of the shoulder in addition to alleviating mild pain.. Prescription painkillers, such as codeine (an opiate – based painkiller) may also reduce pain. Not all painkillers are suitable for every patient; be sure to review options with your doctor.
Exercise – frequent, gentle exercise can prevent and even reverse stiffness in the shoulder.
Hot or cold compression packs – help to reduce pain and swelling. It is often helpful to alternate between the two.
Corticosteroid injections – a type of steroid hormone that reduces pain and swelling. Corticosteroids may be injected into the shoulder joint to alleviate pain, especially in the ‘painful stage’ of symptoms. However, repeated corticosteroid injections are discouraged as they could cause damage to the shoulder.
Shoulder arthroscopy – a minimally invasive type of surgery used in a small percentage of cases. A small endoscope (tube) is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions.
If you experience stiffness in the shoulder joint it is recommended that you seek Osteopathic treatment sooner rather than later in order to prevent permanent stiffness.
How can frozen shoulder be prevented?
Frozen shoulder can only be prevented if it is caused by an injury that makes shoulder movement difficult, in which case the patient should talk to your Osteopath about what exercises can maintain mobility and flexibility of the shoulder joint.