Welcome back Folks!
Today’s post is all about the frozen shoulder, what is it? how does it progress and what treatments actually work?
What is it?
Well to start off with you will be glad to hear that Disney’s Elsa has nothing to do with this shoulder condition! In fact this condition has nothing to do with the cold at all. The medical name for this condition is “Adhesive Capsulitis” which does a far better job of describing the condition. The ball and socket of our shoulder is surrounded by a capsule made of interlinking muscle and fascia (a non elastic, cling film like structure). The purpose of this capsule is to help support the shoulder joint and to contain the synovial fluid (joint lubrication) within. “Adhesive Capsulitis” is when that capsule forms a crease and becomes stuck to itself, imagine when you are trying to tape up a present and the tape folds and gets stuck to itself.
So why does it stick to itself? Often this is due to shoulder immobility for an extended period of time (often due to pain but also sometimes from stroke immobility), however it can also occur when there is direct trauma or surgery to the capsule and the healing process of this damaged capsule tissue can cause it to stick to itself. Unfortunately the most at risk group are post menopausal women & diabetics due to blood supply hormonal changes which affect our bodies loft tissue elasticity, the other group of people most at risk at people with Rheumaticalogical conditions.
Just because you have limited range of movement does not mean you have a frozen shoulder. This condition is very commonly misdiagnosed, so even if you have been told you have a frozen shoulder we recommend you come in for a thorough assessment to make sure that is the case.
Adhesive Capsulitis goes through 3 fairly distinct phases and can take quite a long time to pass through each phase (sometimes up to 2-3 years from start to finish!) they are:
Freezing – the initial painful phase, this last anywhere from 6 weeks to 9 months, movement is usually lost gradually during this phase
Frozen – this phase is generally marked by a reduction of the shoulder pain but a continuation of the significant reduction to range of movement. This phase tend to last 4 to 9 months
Thawing – during this phase the patient tends to gradually regain movement and can last anywhere from 5 to 23 months.
It’s quite a scary thought to consider your shoulder function can follow a worst case scenario of 3 years to return to normal function. However there are many things that can be done to speed up the progress, some things as simple of knowledge of the condition and ensuring you keep the shoulder mobile during times of shoulder pain and discomfort to reduce the chances of frozen shoulder formation.
Treatment tends to vary depending on what stage you are in and the current evidence suggests the best course of action is:
Freezing – Pain relief medication, anti inflammatory medications, steroid injections, acupuncture, assisted and passive range of movement of the shoulder to try and reduce the amount of lost range of movement
Frozen – Working consistently on range of movement exercises that work right to the ends of your current ranges of movement and shoulder strengthening exercises. Sometimes more aggressive forms of treatment are undertaken such as manipulation of the shoulder joint under anesthetic and radio frequency ablation
Thawing – Similar to above Physiotherapy input to accelerate the regaining of shoulder range of movement and strength whilst ensuring correct muscular patterning around the shoulder
So that’s the round up, there is a lot to take on board and we will be sure to explain as much as we can during an appointment with our team. So the take home points, if you have been diagnosed with a frozen shoulder, it may not be the case! It is worth having it assessed by a an experienced and skill Physiotherapist. If a diagnosis of a frozen shoulder is confirmed we will make sure we give you enough skill and knowledge to become independent through the most part of your self treatment and refer you on if we feel a more aggressive form of treatment is suitable for your shoulder.
to find out more book your appointment here.
Kind regards from the Shawe Physio team!