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Adhesive capsulitis, also called frozen shoulder, can occur when you are sidelined due to an injury or certain medical conditions. The resulting stiffness and pain can make everyday activities difficult.
Left untreated, a frozen shoulder can worsen and significantly interfere with daily life. So, what is this condition, and what is the most effective treatment for frozen shoulder?
A frozen shoulder is exactly what it seems like. Your shoulder becomes stuck, and mobility is limited as a result. You don't just don't function either; a frozen shoulder is normally painful.
In the shoulder joint, the upper arm bone's rounded shape fits into a socket in your shoulder blade. The joint is surrounded by connective tissue called the shoulder capsule.
Normally, the shoulder capsule effortlessly expands and contracts with arm movement. However, scarring develops when the tissues become inflamed, tightening the shoulder capsule, restricting movement, and causing pain. If you're in your situation, have a frozen shoulder.
A frozen shoulder is often directly related to a lack of movement. It often occurs in people who've had to keep their shoulder immobile after a broken arm, rotator cuff injury, or surgery and individuals who have conditions that limit their mobility, such as stroke or Parkinson's Disease. Reduced movement due to chronic tightness in your shoulder muscles contributes to an idiopathic frozen shoulder with no obvious trigger.
Our connective tissue adjusts based on how much we move – it tightens with less activity and loosens with more. This adjustment might set off a troublesome cycle: Moving becomes trickier when the joint capsule tightens and occasionally causes discomfort. This restriction hinders movement even more, prompting the tissues to tighten further.
Inflammation has an important role in developing a frozen shoulder as well. After surgery or injury, inflammation occurs in your joint as part of the healing process. This causes pain, swelling, and limited movement, resulting in scar tissue forming, making your joint capsule thicker and tighter.
Systemic inflammatory conditions, such as diabetes and other metabolic conditions, thyroid disease, osteoarthritis, cardiovascular disease, and autoimmune diseases, can also boost the risk of developing a frozen shoulder.
Most people with adhesive capsulitis experience worsening pain and a loss of movement. Adhesive capsulitis can be divided into four phases; your physical therapist can assist you to determine your stage.
During stage 1 of its development, it might be difficult to identify your issue as adhesive capsulitis. You've had symptoms for 1-3 months, and they're getting worse. Shoulder movement causes pain. It usually aches when you are not using it, but the pain increases and gets "sharp" with movement. You'll start to limit shoulder motion during this period and protect your shoulder by using it less.
The movement loss is most visible in "external rotation" (when you rotate your arm away from your body), but you may lose motion once you reach behind your back or raise your arm. Pain is the distinguishing feature of this stage; you might experience pain during the day and night.
At this stage, you've been experiencing symptoms for a period of 3 to 9 months, probably noticing a gradual reduction in shoulder movement and an uptick in pain, especially during nighttime. Although the shoulder retains some mobility, pain, and stiffness impose limitations on it.
Your symptoms have persisted for 9-14 months, and you have a greatly reduced range of shoulder movement. During the early part of this stage, there's still a substantial amount of pain. However, toward the end of this stage, pain decreases, typically occurring only when you move your shoulder as far as you can.
You've had symptoms for 12-15 months, and there is a huge decrease in pain, particularly at night. You still have a limited range of movement, but the ability to complete your day-to-day activities involving overhead motion is improving rapidly.
Often, physical therapists do not see patients with adhesive capsulitis until well into the freezing stage or early in the frozen phase. Sometimes, people are treated for other shoulder conditions once their physical therapist notices the signs and symptoms of adhesive capsulitis. Your physical therapist will thoroughly evaluate, including an extensive health history, to exclude other diagnoses.
Your physical therapist will search for a specific pattern in your decreased range of motion known as a "capsular "pattern" that is "typical with adhesive capsulitis. Moreover, your physical therapist will consider other conditions you might have, like thyroid disorders, diabetes, and autoimmune disorders associated with adhesive capsulitis.
The physical therapist's overall goal is to restore the movement so you can perform your day-to-day activities. Once the evaluation process has identified the stage of the condition, your physical therapist will create a tailored exercise program custom to your specific needs. Exercise is most effective for people who are in stage 2 or higher. Your treatment might include:
Exercises and manual therapy. The physical therapist will help you maintain as much range of motion as feasible and lessen the pain. Your therapist might use manual therapy (hands-on) techniques and range-of-motion exercises to maintain shoulder movement.
Modalities. Your physical therapist might use ice and heat treatments (modalities) to help relax your muscles before other forms of treatment.
Home-exercise program. The physical therapist will give you a gentle home exercise program to help reduce your loss of motion. The therapist will warn you that overly aggressive stretching in this phase may worsen your shoulder pain.
Your physical therapist will suit your treatment activities and intensity to the symptoms and inform you about the proper use of the affected arm. Your therapist will meticulously monitor your progress to ensure a safe healing procedure is observed.
Pain medication. Sometimes, conservative care can't reduce the pain of adhesive capsulitis. In that case, the physical therapist might refer you for an injection of a safe pain-relieving and anti-inflammatory medication. Research has shown that although these injections don't provide long-term benefits for range of motion and don't limit the duration of the condition, they do provide short-term pain reduction.
The focus of treatment during stage 3 is on the return of motion. Treatment might include:
In the final phase, your physical therapist will concentrate on the return of "normal" shoulder body mechanics and your return to normal, pain-free activities. Your treatment might include:
The reason for adhesive capsulitis is debatable, with no definitive cause. Hence, to date, there's no known method of prevention. The condition's onset is usually gradual, with the disease process having to "run its course." Nevertheless, the sooner you contact your physical therapist, the sooner you receive appropriate information on addressing your symptoms most effectively.