A forty-year old woman ”Jane” came in to the clinic last week with a look of exasperation on her face, clutching her left arm. A month ago she had reached behind her to get something out of the back seat of her car and felt a sudden, jarring pain in her shoulder that she described as “the most horrible pain that I have ever experienced.”
Jane had almost no mobility in her shoulder. She was only able to obtain about half of what I would consider normal rotation, and when I asked her to try to lift her arm, the head of her humerus bone jutted straight upwards in an unnatural manner, causing her to wince in pain. (See picture below, right shoulder as example)
Adhesive capsulitis, more commonly known as “frozen shoulder,” is a diagnosis that the medical establishment still does not know much about. Here is what we do know:
1. The typical person who suffers from adhesive capsulitis is a middle-aged woman, in her non-dominant arm. Some studies suggest that ninety percent of frozen shoulders are found in women.
2. Frozen shoulders will often follow trauma. Shoulder surgeries, shoulder dislocations, and tendonitis all tend to increase the likelihood that a frozen shoulder will occur. There is also some literature in the medical establishment that suggests that there may be a viral component to cause.
3. Many frozen shoulders occur for apparently no reason. Otherwise healthy individuals with no predisposing factors are diagnosed with frozen shoulders every day.
4. When diabetics get frozen shoulders, their symptoms are often much worse compared to non-diabetics.
5. One of the hallmark signs of a frozen shoulder is a painful loss of range of motion in the shoulder that may start very suddenly.
6. Frozen shoulders tend to occur in phases.
The first phase is categorized by extreme pain and a progressive loss of range of motion. The first phase can last from weeks to several months.
The second phase of a frozen shoulder is categorized by a dramatic decrease in pain, although the shoulder tends to remain very tight, and at times it will become even tighter than in the first phase. The amount of time that a patient will experience the second phase can also vary widely, from weeks to many months.
The third phase of a frozen shoulder is categorized by decreased tightness in the shoulder and a slow normalization of movement.
Point number six is extremely important in how clinicians deal with treatment of adhesive capsulitis. I have found that it is vital for the doctor and the physical therapist involved to be “on the same page” in terms of treatment. It has been my experience that the first stage of a frozen shoulder is more effectively managed with medication to control pain along with VERY GENTLE range of motion exercises. Early stage frozen shoulders will often become more inflamed and thus worsen if the shoulder is treated too aggressively.
Stretching of the shoulder capsule and therapeutic exercises tend to have a much more therapeutic effect during the second and third phases of a frozen shoulder.
The bottom line is that if you suspect that you may be coming down with a frozen shoulder, you should have it properly diagnosed by your doctor. A good doctor and therapist team should know when the appropriate time is to medicate for pain control, and when it is time to begin other interventions.
As a final note, it is important to have patience when dealing with a frozen shoulder. I have seen patients that experience symptoms for a year or longer. It is important to be methodical and persistent when exercising and stretching. Please make sure that you are dealing with the symptoms at the correct time!
I also welcome any comments or stories that you have in regards to treatment ideas and outcomes. Feel free to share them below in the comments section.
Hi there. I am 80 percent over my painful shoulder after 2 years of it. THANK HEAVENS!!!
What blows me away is that my partner -male – had it before me and then
5 of my friends -all women-came down with it. I cant help but wonder if there is a virus that causes it.
There is some research out there that suggests that, I think. It is weird that so many of your friends have come down with it. I can’t remember the last time that I saw a man with a frozen shoulder.
He want diagnosed but had the same symptoms as me and and took around 20 months to go.
He was a very fit and active 77 when it came on. 80 now and still fit and healthy. Rides his bike 80 ks with no problems.
Manyvthanks for your reply. Di
That is exactly what I suspect! A friend of mine had it (in both shoulders at the same time 😱), and soon afterwards I had it – for 2 agonising years. Now someone I work with appears to be coming down with it. All of us are women. I thought I was mad wondering if it might be viral but my suspicions are supported here.
I am 41, female, type 1 diabetic diagnosed with frozen shoulder in both shoulders, though my non-dominant is worse than my dominant as far as range of motion and pain. I have been dealing for 10 months now. The excruciating pain when reaching or raising has gone away (thankfully) but I am having increased pain when I try to cross my arm in front of me- I can’t acrually get my arms to a point that they are crossed (both painful and not able to get there). I also have increased pain when trying to put my hands on my hips- I can only get to about mid buttock but no higher. I have not been able to put my own bra or tight fitting clothing on for almost a year. I also cannot sleep. Sleep is the worst. If I lay on my back, there is exceptional sharp pain across my collar bones when my shoulders try to fall back. Same occurs when I try to lay on my stomach. As soon as my collar bone area is stretched, sharp unbearable pain. On my side causes shooting sharp pain directly into the side of my shoulder. MRI should labrum tears on both sides as well. PT early on was so painful I quit. Now I do as much yoga and Pilates as I can manage but unsupervised and untrained-just trying every day to get more mobility. I cannot raise either arm high enough to adequately shave under my arms nor can I really put on stick deodorant. Would surgery be a wise consideration? I used to cycle 25-40 miles theee times a week and now can barely stand to hold my arms in same position for 15 miles. What are some other options?
This is a tough one Sara. Instead of having the PT stretch the shoulders, I would perhaps instead have the rib cage, thoracic spine, and soft tissue worked on. In some cases the sleeping comfort and overall comfort tends to improve with this. You may even get back some range with this.
Diabetics do get particularly nasty frozen shoulders. I would try other options prior to having a surgical manipulation given that the manipulations tend to increase inflammation, at least in the short term.
I suffered for about a year with severe shoulder pain with my dominate side. I am a 49 year old female and I had a labrum tear and frozen shoulder repaired 8 weeks ago. I had limited improved during PT, only 10% rage so my doctor suggested a shoulder manipulation. This was incredibly painful because the 72 hour block only worked for about10 hours. I did not proactively take the pain medication once the numbness started to wear off. (That was the longest night and pain of my life) I thought I could get my shoulder moving during the extra time my shoulder was numb. It’s only 2 days in and I start physical therapy today. The pain is finally starting to subside but my shoulder and elbow are very heavy to the point I need to hold them as I walk. I’m presuming this is still the effects of the block but I can not help but feel like I’ve moved backwards. When should I start seeing significant improvement or at least back to where I was before the manipulation? I’m really trying to stay positive..
Hey Celest. Labral repairs do take significant time to heal up. The anchors that the physician used take a good six weeks to heal into place for starters. A normal surgery involving the just a labral repair can take 4-6 months to return to normal function. The frozen shoulder needs to run its course, and it definitely throws a monkey wrench into the whole rehab thing. If you are in the early phase of frozen shoulder, stretching the shoulder usually does not help. I would use pain as a guideline here. If the PT is stretching you all over the place and your shoulder is killing you, I would back off and just let things heal while maybe just doing a very small amount of stretching etc.. Make sure that your pT is aware of the manipulation and frozen shouylder.
Labral repairs do take a significant amount of time to recover from (4-6 months usually). The frozen shoulder thing does make it more complicated. I would let pain be your guide with the rehab. If you are having massive pain with the PT I would let the PT know and back off to a tolerable level. We did do a podcast on labral repairs that you might find useful to listen to.