Let It Go: Feeling Stuck with Frozen Shoulder?
Frozen shoulder, otherwise known as adhesive capsulitis, is a common shoulder condition characterized by painful and restricted active and passive mobility. The shoulder capsule – which is like shrink wrap that secures the joint – undergoes an inflammatory and fibrotic process.
Frozen shoulder has been reported to affect 2% to 5% of the general population. Increased incidence has been found in individuals between the ages of 40 and 65 years old, females more than males, individuals with diabetes and thyroid conditions, and in those with prior episode in the other shoulder. Primary frozen shoulder is of unknown cause (idiopathic), and secondary frozen shoulder stems from known disorders (systemic disease [i.e. diabetes, thyroid disease], extrinsic [i.e. humeral fracture], and intrinsic factors [i.e. rotator cuff injury]). This article will be a general overview of the typical history, presentation, and treatment for frozen shoulder.
History
There are no specific diagnostic criteria for frozen shoulder, but it is characterized by familiar patterns: insidious onset, progressive and worsening pain, and gradual loss of shoulder motion. Night pain that disturbs sleep often motivates individuals to seek medical guidance. Most are comfortable with their arm at their side or anticipated mid-range arm activities. Determining specific stage or irritability levels are based on the ability to sleep through the night, whether the predominant symptom is pain or stiffness, and whether symptoms have been improving or worsening the past month. Considering these will directly impact the plan of care.
Presentation
Frozen shoulder is typically considered a self-limiting condition. This means that it will resolve at some point; frozen shoulder will run its course. It is often a long process, lasting anywhere from 12 to 24 months without treatment. In some incidences, functional limitations may persist for years if left untreated. There are 4 stages of frozen shoulder:
- Pre-Freezing Stage: Mild end-range shoulder pain with normal or minimal loss of range of motion. Individuals are often misdiagnosed with having rotator cuff injury due to similarities in presentation. Symptom duration tends to be 0-3 months.
- Freezing Stage: High pain levels and discomfort with all shoulder motion. There is significant range of motion loss and significant night pain. Symptom duration tends to be 3 to 9 months.
- Frozen Stage: Minimal shoulder pain except at end ranges. There are severe mobility limitations, often feeling rigid. Symptom duration tends to be 9 to 15 months.
- Thawing Stage: Minimal shoulder pain and steady improvement in shoulder stiffness. Symptom duration tends to be 15 to 24 months.
Treatment
Physical therapy and corticosteroid injections are well-supported in research to be optimal non-operative interventions to address frozen shoulder. Shoulder stretching and exercises, joint mobilizations, and shoulder joint corticosteroid injections all lead to improved outcomes. Physical therapists determine appropriate stretches (intensity, frequency, duration) based on the irritability classification; exercise and manual treatment are progressed as an individual’s shoulder pain reduces. Modalities such as heat, ice, or TENS are often used to influence pain and muscle relaxation.
Response to treatment is based on return to functional arm motion and pain reduction. Those who have disabling pain and unchanging symptoms may require surgical capsular release or manipulation under anesthesia. Most individuals respond favorably to conservative interventions, achieving marked pain relief, functional movement, and satisfaction.
