Frozen shoulder is the commonly used name for adhesive capsulitis, a condition that causes the shoulder to be painful and stiff. The diagnosis of frozen shoulder can be difficult to make as usually there isn’t evidence for major tissue damage but patients report progressive reduction of range of motion and acute pain when attempting to move the shoulder.
The structure that is affected during this inflammatory process is the capsule of the shoulder joint, a thick and fibrous tissue that helps keeping together the two ends of the joint and gives attachment to some of the soft tissues surrounding the shoulder.
What causes frozen shoulder?
Unfortunately the cause for this condition is still not fully understood but what research has shown is that certain categories of individuals are at higher risk. For instance, patients suffering from diabetes have a much higher incidence of frozen shoulder than the general population as well as patients with history of heart disease or Parkinson’s disease.
The loss of passive range of motion (the degrees of movement that a joint can be brought through by someone else moving it rather than yourself) is a critical element in establishing a diagnosis of true frozen shoulder. In adhesive capsulitis in fact, the movement is not only restricted by pain but also by a thickening of the joint capsule, caused by the persistent state of inflammation.
The onset, evolution and recovery of frozen shoulder is well described by three stages: the freezing stage, the frozen stage and the thawing stage. Each of them can last up to 6 months, making frozen shoulder one of the slowest shoulder conditions to recover from.
– Onset of non specifically located pain on the shoulder (usually only one is affected at a time but it is not uncommon for both shoulders to be affected)
– Movement aggravates the pain and the less you move the shoulder the better it feels
– The restriction of range of motion becomes gradually worse
– Pain reduces but the stiffness increases
– Movement in any range is very limited and it just feels like the joint won’t move any further
– The range of motion starts freeing up slowly
– Pain gradually disappears completely
What can you do to manage the symptoms of frozen shoulder?
In most cases the condition just needs to go through its course and it is unlikely that any form of therapy will have a real shortening effect on any of the three stages but what you can certainly aim for is a reduction of pain, which makes a huge difference in quality of life especially during the most painful initial stage.
Osteopathy and physiotherapy are the first line conservative therapies for the management of pain in frozen shoulder. A physical examination will be carried out by your practitioner who will then advise on the correct ratio of manual treatment and exercise therapy.
Gentle mobilisation of the shoulder as well as soft tissue release and passive stretching of the joint capsule aim to maintain the flexibility of tissues from the initial stage, making it slightly harder for the inflammation to keep thickening the capsule. Exercise therapy will also contribute to this with simple exercises that your practitioner will guide you through.
What should you do if the pain does not improve?
If the pain does not improve enough to allow you a more comfortable life with conservative treatment your doctor might recommend other alongside forms of pain relief such a corticosteroid injection or in rare cases surgery or shoulder manipulation under general anaesthesia.
Certainly the quickness of the intervention plays an important role in defining the recovery process so if you develop pain in your shoulder for no apparent reason and this continues to worsen over time, get in touch with a physiotherapist or an osteopath who will be able to advise on what the best course of action is.
If you would like to understand more about shoulder pain or would like to find out how we can help you, call our reception team on 02077356813 or visit our website www.kenningtonosteopaths.co.uk.