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Frozen Shoulder: A Not-So Cool Problem to Have

Author: Dr. Britt Dalton, PT, DPT, OCS, COMT, FAAOMPT

Raise your hand if you have a problem with your shoulder. If it is too painful or stiff to raise your arm up, no matter how hard you try, there is a chance you may have frozen shoulder.

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and a loss of motion in the shoulder joint. It often comes on gradually over time. Someone experiencing frozen shoulder may start to notice pain with daily activities, such as brushing her hair, getting dressed, or trying to reach into the back seat of a car while driving. She may find that not only is moving her shoulder painful, but it is stiff as well. Sleep may be impacted due to pain and a limited ability to lay with her arm in certain positions.

To understand frozen shoulder, it is helpful to have an idea of the anatomy of the shoulder. Beneath all the muscles of the shoulder, wrapped around the shoulder joint, is what is called a ‘capsule’. Nearly every joint in the body has a joint capsule. Think of it as like a binding wrapped around the joint. The outer part of it is tough, fibrous-type of tissue that helps to provide support and stability to the joint. The inner layers of the capsule produce fluid for the joint, helping to keep it lubricated and healthy. The capsule stretches some, but not as much as muscles and tendons do. It also shares similar nerve connections as the surrounding muscles, and therefore muscle function can be impacted by changes to the capsule. I

In the case of frozen shoulder, or adhesive capsulitis, the capsule becomes inflamed. This often produces pain, along with muscle guarding. Over time, the ongoing inflammation can result in the inner layers of the capsule starting to tighten up, which results in an even greater loss of motion. This loss of motion will be present whether the person is moving her arm by herself, or with the help of someone else.

In the case of a secondary type of frozen shoulder, there are three sub- categories, or classifications, that indicate the type of problem causing it. The first is systemic, which means that particular metabolic diseases are having an influence on it. An example is diabetes mellitus, which is a very common condition that predisposes someone to frozen shoulder. The second classification is comprised of extrinsic factors, such as heart and lung disease, issues of the neck, or post-surgical problems. The third classification is intrinsic factors, which are comprised of problems with the muscles, tendons, or bones that attach directly to the capsule.

Treatment of frozen shoulder often depends on the clinical presentation. When someone is dealing with severe pain, often felt before or at the same time as the tightness in the shoulder is also felt, then it is important to avoid creating more pain or stress to the tissue. We often say that, with regard to rehab during this stage, if you cause pain, you get no gain. Gentle movement, within a very tolerable range, is encouraged, but not aggressive stretching or strengthening exercises. As frozen shoulder is often influenced by systemic factors in the body, even general exercise, particularly aerobic, that uses the shoulder very little can still be of great benefit. Also, getting good sleep and avoiding a lot of processed foods and sugars can help as well.

When someone dealing with frozen shoulder is feeling only mild pain, or only after being stretched through a certain range of motion, then she can be more aggressive with stretching and other range of motion exercises. Still, it is recommended only to stretch as much as you see progress from it. If your shoulder feels a lot more painful (a little pain during this stage is okay) or stiffer afterward, then you are likely pushing it too hard.

There are some instances in which there may be little to no pain in the shoulder, but it is very stiff. Stretching the shoulder feels like trying to stretch leather. Sometimes in these severe cases, surgery is indicated. In this instance, the doctor would go in through a small incision and surgically cut part of the capsule, allowing it to stretch out a little more. This is usually followed up by rehab to ensure the motion returns afterward.

The important things to remember about frozen shoulder are that it can happen with, or without, an obvious cause. It can be a very painful, debilitating condition, and often is very slow to resolve. A typical resolution, even if everything is going well, often takes several weeks to several months. Rehab of it will not be pain-free, but should stay a very tolerable experience. Finally, catching it early can help, as making activity and lifestyle modifications, as well as certain exercises, in early stages can often help it resolve more quickly.

Remember, if you feel you are experiencing signs and symptoms of frozen shoulder, or any other shoulder problem, we offer free consultations at all of our Integrative PT and Wellness locations.