Adhesive Capsulitis is a mysterious and controversial condition that is better known as frozen shoulder. It has been a known pathology for some time (the earliest descriptions date back to 1872), but there is still a lot of unanswered questions about this shoulder condition. This is because it is hard to define precisely, diagnose accurately, and treat effectively.
Frozen shoulder can be characterized by shoulder pain, usually occurring on one side, accompanied by a progressive loss of mobility. This condition affects about 0.75 to two per cent of the population. This may seem like a small amount but still makes it as common as having naturally red-hair, translating to about one in 100 people. Frozen shoulder is also more commonly observed in those over 40 years old, in females, and with metabolic conditions (i.e. diabetics, thyroid conditions).
So what is frozen shoulder and why/how does it happen?! In the majority of cases the reason frozen shoulder develops remains unknown. The most common explanation to how it develops is that the tendons, joint capsule, and other soft tissues surrounding the shoulder joint become fibrotic and develop contractures. Essentially this means that the shoulder joint becomes inflamed, stiff and develops scar tissue that limit the ability of the long bone of the arm (humerus) to move in its socket. There are two classifications of frozen shoulder:
- Primary: where the condition develops for no apparent reason (no previous event of trauma)
- Secondary: where there is a known cause, such as an event of trauma, surgery, or predisposing factor. Predispositions can be in the form of:
- Systemic factors: diabetes and other metabolic conditions
- Extrinsic factors: fractures, stroke, cardiopulmonary and/or Parkinson’s disease
- Intrinsic factors: rotator cuff pathologies, biceps tendinopathy, calcific tendinopathy, AC joint arthritis.
Those who present with frozen shoulder often report an unexplained onset of shoulder pain where pain increases progressively and is accompanied by a gradual decrease in mobility (active and passive range of motion). Activities that become increasingly difficult in this population are self-care activities such as grooming and getting dressed, performing overhead activities, and activities behind the back (like (un)clasping a bra). Frozen shoulder is thought to progress through three overlapping clinical phases:
- Freezing phase (two to nine months): The most painful phase. There is a gradual onset of shoulder pain at rest, sharp pain with aggravating movements, and pain at night with sleep interruptions.
- Frozen phase (four to 12 months): This could be considered the stiff phase. The pain starts to subside and there is a progressive loss of shoulder motion. Pain occurs only at the extremes of movement.
- Thawing phase (five to 24 months): This is the light at the end of the tunnel. Spontaneous, progressive improvement in functional range of motion occurs.
*Note that some studies suggest that the thawing phase can last closer to three years and that 40 per cent of those with frozen shoulder may have symptoms and movement restrictions beyond three years.
An entertaining fact about frozen shoulder is that a “stuck” shoulder joint doesn’t seem to be so stuck while under anesthetic. Researchers checked shoulder range of motion in five patients undergoing capsular release surgery and found that when they were knocked out, all five patient’s had “significantly more passive shoulder abduction” as compared to when they were conscious. This led to the conclusion that “active stiffness or muscle guarding” could be a large component of decreased range of motion in those experiencing frozen shoulder. The other major factor that could be playing into frozen shoulder is the brain. Our brains are the boss of all function. If the brain has decided that the shoulder joint isn’t to move, well guess what – it’s not going to; and because your conscious mind is excluded from that decision the limitation can feel externally imposed. The thought behind this is that your brain thinks it is doing you a favour by protecting you from yourself.
What I find is most interesting about frozen shoulder is that it is often labeled as a “self-limiting condition” meaning that it will resolve on its own. But as noted above, frozen shoulder can persist for up to 3 years. That’s a long time to be in pain and to be limited functionally in your daily activities and hobbies. Recovery can be significantly improved with physiotherapy intervention. A trained physiotherapist will focus on methods to improve joint mobility and function as well as relieve pain/pressure on the joint. A skilled physiotherapist can provide you with education on your condition as well as strategies to aid with mobility, such as an individually tailored home exercise program, and pain management.
For more information or to book an appointment call 705-380-3312 or visit the website . Surge Physiotherapy is located at 33 King William Street, Suite 204, in Huntsville. Office hours are flexible with evening appointments available (3x/week). Email – email@example.com
Stephanie is a bilingual, Registered Physiotherapist with the College of Physiotherapist of Ontario and the Canadian Physiotherapy Association who is committed to providing a hands on, personalized approach to physiotherapy.
Stephanie, a native to the Huntsville community, developed a passion for health and wellness during her youth while competing in cross-country running, nordic skiing, and track and field. Stephanie has always had a strong caring nature and fell in love with the physiotherapy profession while volunteering at a physiotherapy clinic during high school and university.
Stephanie continued to build on her passion for health care by attending McGill University and completing her
Bachelors of Science in Kinesiology. During her Masters in Health Science of Physiotherapy, completed at the University of Ottawa, she completed internships in orthopaedic clinics, hospitals, home care, and neurology centres.