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.