Frozen Shoulder

Frozen Shoulder

Because of its structure, your shoulder joint allows an amazing variety of motions. You can swing your arms around, lift them to the side/middle/front/back of your body, swing a tennis racquet or golf club, and even throw a ball or a punch. Metaphorically, you can give someone a cold shoulder, shoulder them out of the way, or shoulder responsibility.

It’s this very flexibility, however, that makes your shoulders susceptible to assorted injuries and other conditions. Four of the muscles that control shoulder movement, the rotator cuff, are easily torn, arthritis is common, and the cartilage that’s essential to smooth movement may be torn. One of the more limiting conditions is called Frozen Shoulder, or medically, Adhesive Capsulitis.

What is Frozen Shoulder?

At first, there is minor pain and discomfort in your shoulder, easily ignored or chalked up to overuse or exercise or a bump. It hangs around, however, and over many months it gets progressively more achy; there’s increasing stiffness in your shoulder limiting many movements of your arm. This is not like the intense and often sharp pain of a rotator cuff tear (Making Sense of Medicine 15th June 2018) which is mainly muscular. Rather this feels deep inside the shoulder joint.

Then, again over many months, the pain may subside somewhat, but the stiffness gets even worse sometimes to the point of being barely able to move the shoulder at all.

What’s Happening in Your Body?

The shoulder joint consists of a small shallow socket at the end of your shoulder blade (scapula) into which fits the ball-like head of your upper arm (humerus) which is larger than the socket, like a golf ball on a tee. In fact only about ⅓ of the ball contacts the socket at any one time. The socket is made a bit wider and deeper by a flexible rim of cartilage that runs around its edge, the Labrum.

Surrounding the ball and socket joint is a soft tissue envelope called the capsule. It separates the joint from the rest of the body, and contains a fluid that feels like egg white. Because of this feel, the 15th century physician Paracelsus called it “synovial fluid” arising from “syn-“ meaning “with,” and “ovum” meaning “egg.”

With a normal shoulder the synovial fluid, cartilage, and capsule allow the remarkably wide range of pain free motion described above. With frozen shoulder the parts of this joint get stuck together, and irritated. In addition there is usually a lack of synovial fluid in the joint.

The medical world acknowledge that they really have little idea of what’s happening, but there are two different views of what might be happening.

The Adhesion Hypothesis.

In what seems to be the most common view, the specific culprits of this condition are Adhesions inside the capsule. Adhesions are fibrous bands that form between parts of the body that aren’t supposed to be connected. These are the same as scar tissue that may develop after a cut heals, but they’re inside the body. Sometimes they stick leg muscles together, sometimes they can stick parts of organs to a surgical site, and they may stick together many other parts. The result is almost always pain when you try to move or stretch the stuck parts that are supposed to move independently of one another.

With frozen shoulder adhesions grow between the shoulder joint surfaces significantly reducing movement.

The Soft Tissue Hypothesis.

The other view is that most of the restriction of frozen shoulder comes from ligaments and muscles outside the capsule and that there are few adhesions in the capsule. Rather there may be active processes that increase the fibrous nature of soft tissue structures. The soft tissue becomes less soft resulting in contracture.

What Causes Frozen Shoulder?

Nobody knows what causes frozen shoulder.

What we do know is that people with systemic conditions like diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease are more likely to experience frozen shoulder. We know as well that frozen shoulder may be associated with the injury caused by surgery. We know that lengthy immobilization of the shoulder increases risk. In addition, we see that age and gender are factors as well since people under 40 seldom experience frozen shoulder, and men are much less likely to have the problem.

The Good News.

Frozen shoulder evolves in three phases: The first two I have described above. They are the Painful stage and the Adhesive or Frozen stage. The good news is that even if you do nothing, after one or two years the adhesions seem to resolve themselves or the soft tissue becomes less fibrous, and better range of motion returns to the shoulder. This is the Thawing or Recovery stage that can take place in as few as three months.

The bad news is that while you are waiting for your frozen shoulder to reverse itself, you may be in continual pain with a virtually useless shoulder for a couple of years.

Treating Frozen Shoulder.

There are three approaches to treating frozen shoulder: medications, surgery, and manual therapy.

Aspirin, Ibuprofen or another non-steroidal anti-inflammatory drug (NSAID) as well as corticosteroids are sometimes injected. While this may reduce the pain of frozen shoulder they do little to remove the adhesions that are causing the condition.

Surgery for frozen shoulder is really a last resort, and only in prolonged cases. In this, the surgeon simply cuts the adhesions, and this is usually done arthroscopically.

The treatment most likely to reduce the troublesome adhesions without surgery is medical massage therapy which may be done by a medical massage or physical therapist, a chiropractor, an osteopath, or other physiotherapist. In this the shoulder is stretched and manipulated in such a way as to break up the adhesions, but should be undertaken during the early stages of frozen shoulder if possible.

Preventing Frozen Shoulder.

Moving independent body parts independently of one another is the best prevention for frozen shoulder. That is, for example, keeping the head of the humerus moving within its socket is preventive of adhesions forming in the shoulder joint.

Remember that your shoulders are intimately connected to your upper arm, clavicle, thoracic spine, rib cage, and shoulder blade; one can call this the shoulder complex. Stretches that benefit your shoulders may include as well stretches for these connected parts.