Joint Knowledge: Frozen Shoulder

Does your shoulder hurt when you carry your purse? Or maybe when you try and reach for something behind your seat when in the car?  If it feels stiff or even immoveable, it could be a temporary condition of the shoulder joint called frozen shoulder.

Frozen shoulder (aka adhesive capsulitis) occurs when you experience intense stiffness and discomfort in your shoulder joint to the point where movement at the joint is nearly impossible without pain. Its onset is typically gradual and is a condition that can linger for quite some time, with most cases of frozen shoulder being resolved within one to three years.

 

Anatomy of a Frozen Shoulder

The shoulder contains three bones that form a ball-and-socket joint: the upper arm (humerus), shoulder blade (scapula), and the collarbone (clavicle). The humerus connects to a socket in the shoulder blade. The shoulder capsule is made up of connective tissue that provides structural support for the shoulder joint. Tendons join muscle tissue to bone, and ligaments join bones to bones. Bursae (sacs filled with synovial fluid) cushion the tendons and bones, allowing the rotator cuff (a network of muscles and tendons) to function smoothly.

With so many components, it’s no wonder the shoulder is the most flexible joint in the body.

However, having so many moving parts also places the shoulder at risk for injury and overuse. In the case of frozen shoulder, scar tissue jams the shoulder capsule and inhibits movement. As the tissue builds up, it reduces the amount of synovial fluid in the bursae. Without the cushioning and lubrication, the tendons and bones in the shoulder scrape against each other, causing discomfort and irritation.

 

The Stages of Frozen Shoulder

The process typically occurs in three stages, each lasting several months or more:

1. In the “freezing” stage, moving your shoulder causes significant discomfort that may worsen over time. Your shoulder starts to stiffen, and you may experience intense pain at night.
2. In the “frozen” stage, you may notice a tradeoff: less discomfort, but more stiffness. You may struggle to perform daily activities.
3. In the “thawing” stage, your shoulder starts to regain its original mobility. Full recovery may take 1 to 3 years and usually involves routine physical therapy visits.

 

Causes of Frozen Shoulder

Many factors can contribute to frozen shoulder. The interactions between these factors sometimes make it difficult to pinpoint the exact cause.

Experts believe that the most prominent cause is the buildup of scar tissue in the shoulder capsule. The excess tissue restricts movement and causes chronic discomfort.

The following are risk factors for developing frozen shoulder:

• Being between 40 and 60 years of age
• Being a biological woman (women account for 70 percent of frozen shoulder cases)
• Having had a recent surgery or arm-related injury
• Having diabetes, thyroid disease, Parkinson’s disease, or cardiovascular disease

 

Managing Frozen Shoulder

If you suffer from a frozen shoulder or notice indications of one, obtain a physical exam. The clinician will ask you to move your arm in different ways, such as across your chest or behind your neck to identify the issue. An x-ray or MRI can help identify preexisting problems, such as sprains, strains, or lack of cartilage.

 

Lessening discomfort and improving the shoulder’s natural range of motion are basic steps to addressing frozen shoulder. Depending on the severity of the frozen shoulder and the underlying issues present, your clinician may recommend any of the following:

• Applying an ice pack or hot/cold compression pack to the affected shoulder for 10-to-15-minute intervals throughout the day
• Injecting a corticosteroid into the affected shoulder joint or neighboring tissue
• Taking NSAIDs such as aspirin or ibuprofen
• Undergoing transcutaneous electrical nerve stimulation (TENS) to reduce discomfort
• Injecting sterile water into the shoulder capsule (joint distension) to improve joint flexibility and mobility
• Undergoing assisted shoulder manipulation
• Performing stretches and eventually strengthening exercises to restore shoulder function gradually

 

In rare cases, the frozen shoulder may require shoulder arthroscopy, a minimally invasive surgery in which a small tube is inserted into the shoulder to remove obstructions such as adhesions and scar tissue. This will improve joint mobility.

In most cases, following a regimen of stretching and strengthening exercises will alleviate most of the discomfort and mobility issues. You will typically start with basic stretches such as the cross-body reach, pendulum stretch, and armpit stretch. As you progress, you may move on to strengthening exercises. These typically involve using a light resistance band to rotate your arm inward and outward. Perform these exercises slowly and at a low intensity to avoid discomfort. Consult your clinician if your pain or mobility worsens.

 

Preventing Frozen Shoulder

The earlier you address indications of a frozen shoulder, the better your prospects of recovery. If you experience a stroke or shoulder injury, consult your clinician ASAP to learn about exercises and medications available to you.