Have you ever fallen and tried to catch yourself? Afterwards, did you have achy pain in your affected shoulder and biceps, and stiffness in your shoulder that progressively got worse? Did you have limited movement in your shoulder when trying to raise your arm? Were you afraid to move your arm due to the increase of pain and shoulder stiffness? If you said yes to any of these questions, then you may have, or had, a frozen shoulder (Adhesive Capsulitis). Read the information below for more details.
Frozen Shoulder is …
● Pain and stiffness in the shoulder that progressively gets worse over time.
● Typically seen in older adults between the ages of 40 and 60 and seen more in women than men.
Causes
● Direct cause of the frozen shoulder is unknown.
● It may occur after injury to the shoulder or inflammation in the soft tissue (Ex: Bursitis or Tendonitis, Rotator Cuff Tendonitis or Tears), which is commonly seen in patients who are immobilized for lengthy periods of time during surgery and who are recovering from a shoulder fracture.
Signs and symptoms
● In this first stage, pain occurs in the front outer portion of the shoulder and upper biceps region.
o The patient has limited active (self-movement of the arm) and passive (healthcare provider moves the arm) range of motion.
o Eventually, the shoulder becomes difficult to move.
o This process occurs because the connective tissue surrounding the glenohumeral joint (joint capsule) thickens and contracts, causing a decrease in elasticity and an increase in pain.
o Patients are afraid to move their arm/shoulder further causing increased shoulder stiffness and a decrease in synovial fluid that allows the joints to move freely.
o This stage tends to last for 6 to 9 months.
● During the second stage (Frozen Phase), pain improves, but shoulder stiffness may persist for 4 to 6 months. During this stage, patients tend to have difficulty performing activities of daily living (bathing, washing, and combing their hair, driving, or carrying heavy objects).
● In the third stage (Thawing Phase), patients will tend to have improved shoulder mobility. This phase has an estimated 6 months to 2 years recovery period.
Diagnosis
● Shoulder X-rays assess bone structure and arthritis.
● A shoulder MRI may be necessary to look at the tissue structure and edema (swelling).
Treatment
● This depends on the outcome of the shoulder assessment and imaging results.
● If surgery is not required, then continuous physical therapy to maintain mobility and flexibility is the best treatment plan for frozen shoulder(s).
● The treatment plan may entail the following: a possible shoulder steroid injection to improve mobility, NSAIDS (Aleve, Advil, Naproxen.) to help reduce inflammation and improve mobility,
● Moist heating pads for 20 minutes prior to physical therapy to reduce stiffness,
● Cold compresses for 20 minutes afterwards to reduce pain and inflammation.
● If non-surgical treatment has not been effective, and the shoulder pain consistently gets worse, follow-up with a healthcare provider for an orthopedic surgical consult.
Call to action
If you suspect yourself or anyone else of having a possible frozen shoulder, follow up with a healthcare
provider for a physical assessment.
References
Alila Medical Media. (2019). Shoulder bursa, bursitis. [Illustration]. Retrieved from https://www.shutterstock.com/image-illustration/shoulder-bursa-bursitis-122298685?src=LgujqAxYpFEk2V8pW5kcBw-1-8.
Prestgaard, T. (2019). Patient education: Frozen shoulder (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/frozen-shoulder-beyond-the-basics.
Roberts, J.R. (2018). Adhesive Capsulitis (Frozen Shoulder). Retrieved form
https://emedicine.medscape.com/article/1261598-overview.