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Frozen Shoulder
Adhesive Capsulitis is the medical term for Frozen Shoulder – sometimes abbreviated to FSS (frozen shoulder syndrome). This is a condition which affects the ability to move the shoulder, and usually only occurs on one side.
Frozen shoulder has three phases that the injury will pass through; a freezing phase where the joint tightens up, a stiff phase where the movement in the shoulder is significantly reduced and a thawing phase where the pain gradually reduces and mobility increases. We look in more detail at frozen shoulder symptoms and treatment methods.
Frozen Shoulder Symptoms
The shoulder pain induced by this condition has been described in three phases, so the symptoms will differ depending on the phase of the condition
The Painful (Freezing) Phase
- Gradual onset of aching shoulder.
- Developing widespread pain, often worst at night and when lying on the affected side.
- This phase can last anywhere between 2-9 months.
The Stiffening (Frozen) Phase
- Stiffness starts to become a problem.
- Pain level usually does not alter.
- Difficulty with normal daily tasks such as dressing, preparing food, carrying bags, working.
- Muscle wastage may be evident due to lack of use.
- This stage can last between 4-12 months.
The Thawing Phase
- Gradual improvement in range of movement
- Gradual decrease in pain, although it may re-appear as stiffness eases
- This stage can last between 5-12 months
What is Frozen Shoulder?
Adhesive Capsulitis is the medical term for Frozen Shoulder – sometimes abbreviated to FSS (frozen shoulder syndrome). This is a condition which affects the ability to move the shoulder, and usually only occurs on one side. Sometimes the problem can spread to the other shoulder (approximately 1 person in 5).
The medical term literally describes what is seen in this condition – adhesive meaning sticky, and capsulitis meaning inflammation of the joint capsule. It is thought that a lot of the symptoms are due to the capsule becoming inflamed and 'sticking', making the joint stiff and difficult to move. This is not the same as arthritis, and no other joints are usually affected.
Frozen Shoulder is extremely uncommon amongst young people, and is almost always found in the 40 + age group, usually in the 40-70 age range. Approximately 3% of the population will be affected by this, with slightly higher incidence amongst women, and five times higher prevalence in diabetics.
There are two classifications of frozen shoulder syndromes:
- Primary - No significant reason for pain/stiffness.
- Secondary - As a result of an event such as trauma, surgery or illness.
It is not known exactly what causes this problem, however it is thought that the lining of the joint (the capsule) becomes inflamed, which causes scar tissue to form. This leaves less room for the humerus (arm bone) to move, hence restricting the movement of the joint.
The increased prevalence amongst diabetics (particularly insulin-dependent diabetics) may be due to glucose molecules sticking to the collagen fibres in the joint capsule, which causes stiffness. For this reason, diabetics are more likely to have both shoulders affected.
Hormonal changes may be responsible for the higher incidence amongst women, particularly due to the increased prevalence around the menopausal period.
Some studies have shown that poor posture, particularly rounded shoulders, can cause shortening of one of the ligaments of the shoulder, which may also contribute to this condition. Also, prolonged immobility (such as after a fracture) may cause this condition to develop.
Frozen Shoulder Treatment
What can the athlete do for frozen shoulder?
- Seek medical advice if you think you may have this condition, as early intervention can prevent severe stiffness
- Follow any advice given by medical professionals, particularly if participating in a rehabilitation programme
- Try to keep the shoulder moving – even if it is just small pendular movements. If movement is very painful this should be ONLY under the guidance of a qualified therapist such as a Physiotherapist, Chiropractor or doctor
What can a Sports injury professional do?
- This condition is usually managed conservatively, with surgery as a last measure if all other attempts fail.
- Arrange a course of physiotherapy or sports therapy.
- Oral steroids and/or anti-inflammatory medication to reduce inflammation.
- Direct injection of steroid medication into the joint to reduce inflammation.
- Nerve block – a short term pain relief option, which is usually very effective.
- Surgery if the above fails.
What does surgery involve?
- Surgery may be performed in some cases, following failure of conservative treatment methods.
- Arthroscopic capsular release is the technique used most often.
- This involves dividing the thickened shoulder capsule.
- Surgery is followed by an aggressive rehabilitation protocol which must be adhered to.
What is the likely outcome?
Most cases will resolve on their own or with physiotherapy over a 1-3 year period, however it is a slow recovery process.
Some studies have reported positive results following arthroscopic surgery to release the tight capsule, however this is currently only offered to patients who have not improved with conservative treatment
