Brief Overview
Adhesive capsulitis, more commonly referred to as Frozen Shoulder, involves stiffness and pain in the shoulder joint. By nature, the condition can be a very slow progression, so much so that there are often reports of “I just woke up one day and couldn’t move my arm!” This can make it difficult to identify the condition since the symptoms are subtle, and while there is discomfort, it was not limiting any daily function.
The condition can begin as tendinitis or repetitive stress injury and then morph into a frozen shoulder. To help differentiate… With tendonitis, you can still move your arm throughout its range but with pain. A Frozen Shoulder typically has a “stopping point” to your motion. For example, you may want to reach overhead but just cannot make your arm get there.
In the simplest terms, the inflammation in the shoulder starts settling into more of a scar tissue-like substance and allows for “adhesions” to affix to the shoulder joint capsule. These adhesions are much more rigid than the stable yet flexible capsular tissue. As a result, proper movement patterns are prevented from occurring and cause a “freezing” of the arm – a very restrictive pattern of movement.
While Frozen Shoulder can resolve itself, it can take up to 24 months to regain full mobility and function. Physical therapy is typically employed to help expedite the process.
Potential Causes
Having to keep a shoulder still for a long period of time increases the risk of developing a Frozen Shoulder. This can be a result of pain following repetitive stresses, such as painting a room, vacuuming for long periods of time, working with tools that require twisting and/or gripping, as well as athletic activities, including throwing a ball, weightlifting, or golf. Other causes can be post-surgery or breaking an arm.
Possible Symptoms
Frozen shoulder typically develops slowly in three stages.
Freezing stage (2-8 months) - Any movement of the shoulder causes pain, and movement becomes limited.
Frozen stage (4-10 months) - Pain might lessen during this stage, but the shoulder becomes stiffer and more difficult to use.
Thawing stage (5-24 months) – Movement of the shoulder begins to improve.
High-Risk Population
Females 40 and older
Recovery from surgery
Diabetes
Cardiovascular disease
Parkinson's disease
Types of Treatment
Traditional treatment for frozen shoulder consists of movement activity. The challenge: How much movement is good? How much is too much?
Frozen Shoulder is usually painful as a result of inflammation, and it can be difficult to determine how to self-treat. If you move your arm too much, the inflammation can worsen, and the pain can increase significantly. But, if you do not move your shoulder enough, no progress is possible, and the pain level will remain the same.
The solution: When self-care has failed, skilled manual physical therapy is the number one treatment option for Frozen Shoulder. An experienced physical therapist (PT) will do a thorough evaluation, including medical history and physical exam, to determine where you are in the recovery stage. Only an experienced therapist will be able to help determine how hard to push when to push and in what movement motions you should be moving.
Manual passive stretching is the cardinal rule in treating Frozen Shoulder. We must challenge the end range of your motion without triggering more inflammation. The manual work must also be supplemented with appropriate self-stretching exercises to be performed daily and sometimes, depending on the severity, even hourly. If your PT determines that progress has plateaued, he/she may recommend a follow-up to the orthopedist to discuss possible injections and/or appropriate medications. Since it is not in our scope of practice at Davis PTSR to make such recommendations, we refer to the physician for further evaluation.
The key: Early detection and proper treatment of a Frozen Shoulder can make it be just a quick hiccup in your life. But the contrary if prolonged and not easily identified as an issue, it can take up to 18 months to heal. So step one is being properly evaluated as soon as you think there may be a problem. As PTs, we are trained to assess the shoulder and determine the issue(s). Often a few simple exercises can mitigate the pain and get you back on track.
Of note: New Jersey is a direct access state for physical therapy, which means you do not have to see a physician in order for us to evaluate your shoulder or any other condition treatable by a PT.