SHOULDER PAIN–DO I HAVE A FROZEN SHOULDER?

frozen shoulderTechnically called “Adhesive Capsulitis,” this painful condition occurs in roughly 2% to 5% of the general population.  Women tend to be more affected than men, and the age of onset is typically 45 years and older.  For those individuals unfortunate enough to experience this debilitating condition, 20% to 30% will tend to get it in the other shoulder.

WHAT IS FROZEN SHOULDER (ADHESIVE CAPSULITIS)?
Frozen Shoulder is the stiffening of the shoulder due to scar tissue, resulting in painful movement and loss of motion.  The actual cause of Frozen Shoulder is debatable.  Some believe it is caused by inflammation of the lining of the joint, while others believe it is a result of autoimmune reactions, where the body launches an “attack” against its own tissues.  Other possibilities include:
frozen shoulder

  • Immobilization of your arm, such as in a sling, after fracture or surgery
  • Reactions after trauma or surgery
  • Pain from other conditions, such as arthritis, bursitis, tendinitis, or rotator cuff tear, that has caused limited mobility of the shoulder due to pain

HOW DOES FROZEN SHOULDER PROGRESS?
Frozen Shoulder is generally broken down into 4 stages (some theories condense Stages 1 and 2 into 1 Stage).  Most individuals start with worsening pain followed by a loss of range of motion.

STAGE 1–PRE-FREEZING

During this Stage, it is often difficult to identify one’s problem as Frozen Shoulder.  Symptoms have gone on for 1 to 3 months and are getting worse.  There is pain with active movement (you move your arm) as well as passive movement (someone else, such as a Physical Therapist, moves your arm).  Generally, one will experience “aching” while at rest, and “sharp” pain with movement.  Because the pain is increasing with active movement, one tends to limit all motion and will tend to “splint” the arm (hold tightly against the body), which leads to further loss of motion.  This Stage is experienced both during the day and at night.
STAGE 2–FREEZING
     Symptoms now have lasted between 3 and 9 months, and shoulder mobility continues to diminish while pain intensifies, especially at night.  The shoulder still has a limited amount of motion, but is extremely limited by pain and stiffness.
STAGE 3–FROZEN
     Symptoms have now lasted from 9 to 14 months, and shoulder movement remains significantly decreased.  Pain persists during the early phase of this Stage, but gradually diminishes by the later phase.  However, pain is most notable at the extreme end ranges of motion.
STAGE 4–THAWING
     Typically occurs after 14 months, where there is significant reduction in shoulder pain, especially at night.  Motion remains limited but is steadily improving, allowing one to complete one’s normal daily activities.
HOW DO I KNOW IF IT’S FROZEN SHOULDER?
     Getting a thorough evaluation by a Physical Therapist is critical in determining whether the shoulder is actually “frozen,” but often we don’t see an individual until well into the FREEZING or early FROZEN phase.  Your Physical Therapist will look for certain movement limitations called a “capsular pattern” that is typical with Frozen Shoulder.  In addition, a detailed medical history should be conducted to look for other contributing factors such as diabetes, thyroid disorders, or autoimmune disorders.
HOW CAN PHYSICAL THERAPY HELP WITH FROZEN SHOULDER?

shoulderThe overall goal is to restore motion and decrease pain to allow the individual to resume their normal daily activities and life roles.  During Stages 1 and 2, treatment focuses on maintaining as much range of motion as possible, as well as keeping pain manageable.  This typically includes a combination of manual therapy techniques and gentle stretching to increase mobility of the shoulder.  A home exercise program is essential to maintain the gains in range of motion attained during one’s Physical Therapy session.  In Stage 3, the focus of treatment will also be on improving shoulder mobility, and manual therapy techniques and stretching tend to get more aggressive.  Strengthening exercises will also typically be added in the clinic and to one’s home exercise program as well.  In Stage 4, the final stage, focus will be on the return to “normal” shoulder mechanics with an emphasis on the return to one’s normal panfry activities.  Manual therapy, stretching, and strengthening will continue to be progressed during this time.

therapy in wilmingtonCAN FROZEN SHOULDER BE PREVENTED?
Since the cause of Frozen Shoulder is debatable with no known definitive cause, there is no known method of prevention.  The onset is generally gradual, with the disease process needing to “run its course.”  Physical Therapy can, however, assist in regaining mobility and decreasing pain during the course of the 4 Stages.

     If you or a loved one are experiencing any of the symptoms described above, don’t wait months to take action–call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your free, 30-minute consultation to see how Physical Therapy can help you.  Don’t delay–schedule now.
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