Most people have heard that opposable thumbs are what set humans apart from the rest of the animal kingdom. You could also argue that our shoulders are the most uniquely human joint. We’ve developed a ball and socket joint where the ball is significantly larger than the socket. Get rid of the supporting soft tissue and you could compare it to a golf ball on a tee.
This adaptation gives humans the mobility necessary to master the art of throwing objects with precision and speed. On the other side of the pros/cons coin, this set up means that soft tissues such as the shoulder labrum, joint capsule, and rotator cuff muscles have to do ALOT of work to keep the golf ball from falling off the tee. It’s common to see these structures suffer problems, which is what we are discussing here with Frozen Shoulder (Adhesive Capsulitis).
What is it?
Frozen Shoulder is an accumulation of scar tissue that makes movement difficult and painful. Interestingly enough, the specific cause of frozen shoulder is still up for debate in the medical community, even though it is an increasingly common disorder. Some think the scar tissue accumulates due to inflammation of the joint. Others think it is an autoimmune disorder where your immune system mistakes your own tissue as something bad and attacks it.
Although we aren’t totally sure of the exact mechanism, we do know that it is common to see Frozen Shoulder secondary to another pathology or procedure. Common scenarios include after a rotator cuff tear, labrum tear, tendinitis, bursitis, or any form of shoulder surgery. In a nutshell, when a person stops moving their shoulder for whatever reason, it has a chance of “freezing”.
With this said, there are also cases of the shoulder “freezing” for no apparent reason!
Phases
There are 3 distinct phases of Frozen Shoulder that help patients and Physical Therapists identify the impairment.
- Painful Phase (1-3 months): During this phase, the symptoms seem to continually get worse. It’s common for your shoulder to ache constantly and movement makes it even worse. You start to protect the shoulder and limit motion. It’s especially difficult to rotate your arms away from your body, reach overhead, or reach behind your back.
- Frozen (3-12 months): During the early part of this stage, your shoulder is painful with almost any movement, and you notice that you’re losing more and more range of motion when you test how far it can move. During the late part of this stage, there is considerable loss of shoulder range of motion, while pain actually starts to reduce unless you push it. The constant pain starts to be replaced with a feeling of constant stiffness.
- Thawing (6-15 months): Pain is now decreasing rapidly, and it’s finally becoming easier to use your shoulder. Stiffness is still present, but it seems like you can start to reach behind your back and do overhead activities again.
Treatment
You might have noticed that the timeframe for Frozen Shoulder can vary substantially. This variability depends on each specific case, with the fastest possible recovery occurring with the guidance of a Physical Therapist. Treatment for each stage of Frozen Shoulder is unique, and PTs have been trained to know when, as well as how to shift treatment in order to progress as fast as possible.
The earlier the treatment begins, the easier it is to get a hold of the symptoms and make progress, so if any of this sounds familiar, be sure to contact your local PRN clinic so you can stay in charge of your shoulders!
Want to learn more about Frozen Shoulder? Check out the American Physical Therapy Association’s take on the subject.