It’s not uncommon for individuals to experience shoulder pain now and then. This pain is common especially if they recently engaged in activity that involved excessive use of the shoulder area. However, when a person’s shoulder remains chronically stiff and sore, or at the point where their range of motion becomes noticeably limited, they may have a condition called adhesive capsulitis, or frozen shoulder.
Anatomy of the Shoulder
The shoulder capsule is where bones and multiple muscles meet, including rotator cuff muscles such as the subscapularis, teres minor, infraspinatus, and supraspinatus. Bicep muscles coming from the upper arm also attach to the shoulder capsule, along with muscles under the arm, sometimes referred to as the axillary fold. The subacromial bursa, a group of muscles and tendons that support the rotator cuff, play an essential role in the capsule as well.
When the strong connective tissue that surrounds the shoulder capsule (joint) becomes inflamed, an individual will experience pain and stiffness. This begins a vicious cycle where an individual will then avoid using their shoulder, causing the tissue around the shoulder capsule to thicken and become even more tight, resulting in even less motion. Eventually, an individual with adhesive capsulitis may not be able to move their shoulder at all, hence the term “frozen shoulder.”
Risk Factors
Frozen shoulder typically occurs after age 40 and women tend to experience it more than men. Sedentary people are also more vulnerable as well as individuals with cardiac disease, an under or overactive thyroid, rheumatoid arthritis or shoulder osteoarthritis, diabetes mellitus, as well as people recovering from surgery or an injury such as a stroke (hemiplegic shoulder), or a broken arm that may further limit the mobility of the shoulder area. Individuals with a history of rotator cuff disorders, bicep tendonitis, a humeral fracture, or calcific tendonitis also have a greater propensity to developing adhesive capsulitis. Individuals with cervical radiculopathy (degenerative changes in the cervical region) may also be more vulnerable to frozen shoulder.
Stages and Symptoms
The first stage, known as the acute adhesive or freezing stage can last anywhere from 6 weeks to 9 months. Individuals will notice chronic pain that gradually becomes worse over time and resting pain at night during sleep is common. Muscle spasms may occur as well. The ability to move one’s shoulder gradually decreases over this period.
The second stage, the fibrotic stage, is commonly referred to as the frozen stage. During this period an individual will notice their pain has decreased, but their shoulder area is much stiffer. Individuals may have great difficulty reaching up for items, as well as reaching over their heads. This stage can last anywhere from 2 to 6 months.
The first two stages are eventually followed by the last (recovery) stage. This last stage can last anywhere from 6 months to 2 years. During this stage, pain continues to lessen and the range of movement improves, albeit very gradually.
Physical Therapy Treatments
Considering adhesive capsulitis could potentially last up to 3.5 years, it’s clear that effective treatments for a frozen shoulder are imperative. No one wants to deal with such a painful, restrictive condition for such a long period of time.
This is why it is so important to receive a proper diagnosis and begin physical therapy treatment soon after. A professional physical therapist can help decrease the pain associated with a frozen shoulder. They will introduce exercises designed to stretch key muscles and improve range of motion. Eventually, they’ll introduce exercises that will help strengthen muscles so the condition will not reoccur.
If you or someone you know has a frozen shoulder, we can help! Please contact Cawley Rehab at 570-208-2787.
