What I should have known about frozen shoulder

10 years ago, I knew very little about what a frozen shoulder was. 

I had a client at the time who had enough movement in his shoulders to do most things but he could not reach up above his head and he could not scratch his back. Thankfully for him, most of the important personal functions that need to be performed using the shoulder joint are done within a fairly narrow range of motion.

As a well-meaning health professional, I tried everything to help my client improve his shoulder range of motion.  I even tried motivational techniques to help my client stick to the exercises when they weren’t working.  Little did we know at that stage of the process, there was nothing that could have been done from a mechanical or therapeutic perspective.

So what do I know now that would have saved me and my client a lot of time and frustration, not to mention my client’s money?

What is frozen shoulder?

Frozen shoulder is the common name for a condition known as adhesive capsulitis.  It often starts in a gradual, subtle way when the shoulder stays inflamed for a long time, leading to a thickening of soft tissue around the shoulder joint and a sticking (or adhesion) of structures that would have previously moved independently.

Adhesive Capsulitis reduces shoulder range of motion in all directions and progresses over a 15 to 24 month period in three phases:

• Painful/acute (“freezing”) stage: people experience pain and a reduced range of motion that persists from 3 to 9 months;
• Adhesive/chronic (“frozen”) stage: this is when there is almost a complete loss of shoulder range of motion but pain is experienced only at the end of the range of movement. This phase progresses from the 9 month mark up to the 15 month mark;
• Recovery (“thawing”) stage: this is when shoulder range of motion gradually improves with minimal pain from the 15 month mark up to 24 months¹ after the initial injury.

Who is at risk of developing a frozen shoulder?

Researchers have spent a lot of time studying adhesive capsulitis and the sort of people who suffer from it include¹:

• 2-5% of cases are from the general population;
• 10-38% have diabetes;
• 20-30% develop adhesive capsulitis in the opposite shoulder;
• 70% of cases are in women;
• Adhesive capsulitis is most common in people older than 40;
• Adhesive capsulitis is slightly more common in the non-dominant arm.

This data helps us to identify patterns in the people who develop adhesive capsulitis.  However, we are no closer to predicting who will ultimately suffer from a period of frozen shoulder.

What causes frozen shoulder?

There are two main forms of adhesive capsulitis: primary adhesive capsulitis and secondary adhesive capsulitis. Primary adhesive capsulitis describes frozen shoulder with an unknown origin.  Secondary adhesive capsulitis has associated precipitating factors such as a prior injury, shoulder surgery, disuse or prolonged immobilisation of the shoulder or metabolic disorders such as diabetes or thyroid diseases².

How is frozen shoulder treated?

During the “freezing” and “frozen” stages the most effective treatment is to simply control shoulder pain through analgesics and cortisone injections.  The treating clinician will usually notice that their treatment of the affected shoulder is having no effect.  This is when it is decided the patient has a possible frozen shoulder and a more accurate diagnosis can be made.  This seems a little late in the piece but there a currently no other ways of diagnosing frozen shoulder.

During the latter “thawing” stage a greater emphasis is placed on physical therapy and manual therapy³ to restore range of motion and functional strength.

How is frozen shoulder going to impact my performance at work?

Recovery from adhesive capsulitis gets slower with age and with the degree of manual labour in a job role¹.  These factors need to be considered when returning workers affected by frozen shoulder back to work.

Knowing these facts would have saved me and my client with frozen shoulder a lot of time.  It would have saved my client from my well-meaning but futile attempts at improving his shoulder range of motion and I would have been able to provide a degree of hope to an elderly gentleman who, when we parted company, gave up on trying to improve his shoulder dynamics altogether.

KINNECT treats frozen shoulders in Cairns, Brisbane, Townsville, Gladstone and a number of other locations around Australia.

References:

1. Minichillo, J., Granado, M. (2014). Adhesive Capsulitis. Rehabilitation Reference Centre. Retrieved October 1, 2014, from http://search.ebscohost.com/login.aspx?direct=true&db=rrc&AN=T708531&site=rrc-live
2. Tasto, J.P., Elias, D.W. (2007). Adhesive Capsulitis. Sports Medicine & Arthroscopy Review. 15(4), 216-221. doi: 10.1097/JSA.0b013e3181595c22
3. Levine, W.N., Kashyap, C.P., Bak, S.F., Ahmad, C.S., Blaine, T.A., Bigliani, L.U. (2007). Nonoperative management of idiopathic adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 16(5), 569-57. doi: 10.1016/j.jse.2006.12.007