By in Joints & Muscles, Osteopathy

What is Frozen Shoulder?

I had a patient the other day who reported a shoulder pain. She went on to say that a friend of hers had said it must be frozen shoulder. So, I did a very quick examination and was, with great relief, able to definitively say it was not frozen shoulder.

What is Frozen Shoulder?

As a term, frozen shoulder, may not mean a lot to most people but it can be an extremely debilitating condition that usually lasts between 1 and 30 months. It is self limiting, meaning it gets better on its own but the time scale, level of pain and range of movement limitation over the course of the condition is the hardest to deal with.

Frozen Shoulder is the Layman’s term for the condition “Adhesive Capsulitis”. This means that the joint capsule surrounding the ball and socket joint of the shoulder tightens up, gradually reducing the amount of movement available at the joint.

Who Does the Condition Typically Affect?

It is not well understood why the process starts but it will affect between 2 and 5% of the population although this increases to over 10% in the diabetic population. Incidence is higher over 50 years old, it can be more common in females and it does have a predictable pattern once symptoms have been identified.

The 3 Stages of Frozen Shoulder

Adhesive Capsulitis follows three distinct and separate processes. The initial phase, known as “freezing” stage, causes reducing range of motion at the joint with increasing pain of specific movements. The most affected movements are abduction (taking the arm out to the side and above your head) and Internal rotation ( turning the arm behind your back and reaching up towards the shoulder blades) so the first thing ladies notice is difficulty doing up their bra, and men report pain when putting their arm into a shirt or coat.

Second phase is the “frozen” stage. Pain will tend to reduce but the limitation in shoulder movement will be functionally restrictive. The final stage is, predictably, the “thawing” stage. This stage is still mostly pain free, while the range of motion gradually increases as the capsule becomes more flexible again.

Each of these stages typically takes 4-8 months to go through. It is different for each person but does follow a fairly typical presentation pattern.

How is Frozen Shoulder Treated?

Studies have shown that the average time it takes from the onset of symptoms to presenting for medical evaluation is 9 months so expectations of early treatment is difficult to evaluate. However, management of patients should include conservative treatment and exercise before surgical intervention should be considered.

This is why I was so concerned when this lady mentioned frozen shoulder the other day, and why I was so pleased to let her know it wasn’t Adhesive Capsulitis.

So what can be done in clinic?

I have discussed Myofascial trigger points in previous blogs and have mentioned the contribution they can have to the amount of pain experienced in lots of pathological conditions. I have found it to be especially prominent in adhesive capsulitis and have had patients report significant reduction in pain after working on the associated trigger points. I should point out that this type of treatment is not comfortable by any means but the difference the majority of my patients report after the treatment is that they have less pain and an overall increase in range of movement.

There will always be differences and comorbidities involved in the individual presentations so it is important to acknowledge that treatment can not be universally prescriptive. Conservative manual treatment needs to be tailored to the patient to take into account the history, presenting symptoms, duration of symptoms plus a multitude of individual factors that may affect the outcome.

The main target of this treatment for shoulder issues, or any issue, to be honest, is to reduce the pain and improve the function of the joint. Shoulders can respond extremely well to manual treatment and with a little proactive exercise between treatment, patients can help themselves to a resolution of whatever the cause of their pain.

I have had several patients present to me over the years with what I felt was developing adhesive capsulitis, however, I have to question my diagnosis in the cases that have resolved without going through the typical stages.

Was I wrong about the adhesive capsulitis, or, did manual therapy prevent the condition from developing further. After all the evidence collected has indicated there is very little we know about how treatable the condition is in the early stages. As I mentioned earlier in the article, most people do not present to a health professional until an average of 9 months after symptoms have begun.

This article was written by Matthew Oliver M.Ost DO ND. Osteopath. 

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