Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, medically known as adhesive capsulitis, is a condition that can gradually limit your shoulder’s movement, making even the simplest tasks feel impossible. This condition progresses slowly, making it difficult to pinpoint when your condition started.

At Suarez Physical Therapy, we specialize in treating patients in Las Vegas to regain their shoulder mobility after a diagnosis of frozen shoulder. Our approach involved precise diagnosis and personalized treatment plans that address your condition. Whether you are in the early stages of discomfort or experiencing significant limitations, we will guide you through recovery.

An Overview of Frozen Shoulders

Anatomy of the Shoulder

Your shoulder is the most movable joint in your body, and that flexibility makes it susceptible to injuries. It is the freely movable joint through which you can move your arm in directions like:

• Up

• Down

• Sideways

• Backward

• Forward

• Rotate

The shoulder joint is where the top part of your upper bone, the humerus, meets the small circular hollow of the shoulder blade or scapula called the glenoid. This socket is made deeper by a ring of cartilage known as the labrum to give it stability during movement.

Around this joint are muscles and tendons, known as the rotator cuff, which helps connect the shoulder bones. The entire joint is surrounded by a fibrous structure known as the joint capsule, which comprises connective tissue. This fluid-filled capsule secretes synovial fluid, a slippery fluid that reduces friction within the joint, enabling easy joint movement. The capsule is stretched every time you move your shoulder, and the synovial fluid ensures that the bones and cartilage do not grind against each other, causing pain.

What Is Frozen Shoulder?

In the case of a frozen shoulder, the flexible capsule explained above becomes inflamed, thickened, and contracted to limit the joint's mobility. The internal walls of the capsule that were once smooth become coarse and sticky, resulting in stiffness and pain. This process is gradual and could take a long time. It gradually builds up and can take months or years before manifesting itself.

Frozen shoulder progresses through three stages: freezing, frozen, and thawed (explained in the section below). Every phase has its difficulties and hassles, and the patients have a restricted quality of life as they are bound to feel irritated.

During the freezing stage, shoulder pain may be mild and progress to severe pain, where you cannot lay on your side or lift your arm. In the frozen stage, the pain may decrease, but the stiffness increases, movement becomes limited, and you cannot bend your joints. In the final or thawing stage, mobility may be slightly improved. However, the whole process may take several months to even years to heal.

The cause of frozen shoulder is not fully understood. It stems from inflammation, joint capsule shrinkage, and scar tissue formation. This can develop without any specific reason or after an injury or surgery, during which a person cannot move the shoulder for some time. However, the signs of the frozen shoulder are general and hard to detect. Also, the condition worsens slowly, and you might not know when and how it started.

Symptoms and Causes

Symptoms

Frozen shoulder starts with vague, throbbing discomfort in the shoulder area. Moving the arm becomes excruciating, and the discomfort is usually felt on the upper arm. However, as the condition advances, the pain becomes unbearable. You cannot lift your arm or put your hand above your head or behind your back. The pain may worsen at night when one cannot find a comfortable sleeping position.

The stiffness is as if your shoulder is frozen, rigid, and immobile, and every attempt to move feels like moving a cement structure that is fixed at the shoulder joint. This constant pain can become invasive in your day-to-day life, making dressing up a chore, reaching out for things a struggle, or driving a nightmare.

As mentioned above, three distinct stages mark the gradual progression of this condition, namely:

1. The “Freezing” Stage

During the freezing stage, shoulder pain worsens over the days. The pain increases at night and may be associated with a gradually decreasing range of motion.

At this stage, the inflammation within the joint capsule is at its worst, and the tissues become thickened and contracted. While using the capsule, movement is limited, and as the capsule is made narrower, the movement is significantly reduced, and the pain can be intense.

This stage may take six weeks to nine months, and the severity of the manifestations may differ between periods.

2. The “Frozen” Stage

When you transition to the frozen stage, the pain may reduce and be replaced by increased stiffness. The shoulder becomes stiff, making it hard to move around. Joint movements are restricted. Tasks like extending your arm to pick up a wallet or adjusting your shirt become very difficult.

While the pain level in this stage is not as high as in the freezing stage, the stiffness is just as irritating. This stage can take four to six months, and often, you feel your shoulder is frozen to the spot.

3. The “Thawing” (Recovery) Stage

The thawing stage is the process of gradually regaining your shoulder’s flexibility. Your range of motion improves slowly as the joint capsule becomes less stiff and tight. While the shoulder returns to its standard functionality, it cannot be perfect.

The thawing stage can take six months to two years, depending on the severity of the condition and the treatment you have received. Healing is generally slow, but with adequate rest and physiotherapy, most patients can regain their full range of movement.

Causes

The precise cause of frozen shoulder is still unknown. However, the condition is thought to be caused by joint capsule inflammation, which leads to scar tissue formation. The capsule's inflammation leads to scar tissue forming that becomes hard, thick, and contracts.

Thus, less space is available in the joint, and free movement becomes restricted. This process may occur naturally or after an injury or surgery that limits shoulder use. In some cases, the condition arises from nowhere, which is the worst part since frozen shoulder can happen to anyone at any time.

Who Is Most Likely To Suffer From Frozen Shoulder?

Persons likely to suffer from frozen shoulders include the following:

• Older People

Frozen shoulder is more prevalent in people between 40 and 60. The older you are, the higher your chances of suffering from frozen shoulder. The aging process, the deterioration of your body over time, and the loss of tissue elasticity have something to do with this condition.

• Women vs. Men

Frozen shoulder is more common in women than in men, although the cause of this gender disparity is not well understood. Some causes may include hormonal changes, especially during the menopausal period, since hormonal changes tend to alter the connective tissues in the body.

• People With a Recent Shoulder Injury

If you have recently suffered a shoulder injury, such as a fracture or rotator cuff tear, or recently undergone surgery restricting your shoulder movement, you are likely to develop frozen shoulder. Stiffness or lack of movement after an injury results in the formation of scar tissue in the joint capsule, which paves the way for this disease.

• Persons Living With Diabetes

Diabetes patients are four to five times more likely to develop frozen shoulder, which can affect up to 20% of diabetic patients. It is still unclear how exactly diabetes is associated with frozen shoulder, though it is postulated that increased blood sugar levels may lead to swelling of the joint capsule.

• Patients Suffering from Other Health Diseases and Conditions

Some other diseases, including thyroid, cardiovascular, and Parkinson’s disease, are also linked to frozen shoulder. These conditions may alter connective tissues' functionality, making them prone to inflammation and scar tissue formation.

Diagnosing and Testing Frozen Shoulder

The diagnosis of frozen shoulder is made after a detailed history, physical examination, and patient questioning regarding the symptoms. Your physical therapist asks about the pain's intensity, onset, and evolution. They could also ask you if you have ever had a shoulder injury or surgery and if you have any medical conditions, like diabetes or thyroid, that may predispose you to this condition.

The doctor should also identify your daily activities and any movement that worsens the pain or stiffness.

After gathering your history, your therapist could perform a series of tests to assess your shoulder’s range of motion. These tests distinguish frozen shoulder from other conditions that might cause similar symptoms, such as rotator cuff injuries or arthritis. The primary symptom of frozen shoulder is a significant restriction in both active and passive range of motion.

Active range of motion refers to the movement you can achieve independently, while passive range of motion involves the doctor moving your arm for you. In cases of frozen shoulder, both types of movement are limited, indicating that the joint capsule is affected rather than just the surrounding muscles or tendons.

The Physical Exam Procedure

In the physical assessment, your doctor will check how you can move your arm. They may request that you make basic movements, such as lifting your hands above your head, reaching across your chest, or turning your shoulder.

Any of these movements can help establish the kind and degree of stiffness present. Some of these exercises might cause discomfort, mainly when inflammation is rife in the initial stages of frozen shoulder. The therapist will document which movements are to be avoided and the degree to which they are limited.

After that, your physician may assess a passive range of motion, where your provider moves your arm and determines the available range of motion without muscle contraction. If you have a frozen shoulder, these movements will be equally limited if you try them alone. The rigidity experienced during these tests is called the ‘capsular pattern,’ which strongly suggests a frozen shoulder. This pattern is not typically observed in other shoulder pathologies; thus, it forms a significant part of the diagnosis.

Sometimes, to eliminate other possibilities for your signs and symptoms, your provider may refer you for imaging tests like an X-ray, MRI, or ultrasound. These tests will not diagnose a frozen shoulder directly but can rule out other possible causes, such as arthritis, fracture, or rotator cuff tear.

For example, an X-ray may show that the bone has developed bony outgrowth, such as bone spurs or other structural features causing your pain. An MRI or ultrasound may reveal problems with the soft tissues around the joint.

Management and Treatment

Frozen shoulder is managed and treated depending on your particular case. The target is to minimize the pain and regain as much lost function as possible. The treatment plan that your doctor offers depends on the stage of your disease, your general health, and your reaction to the initial treatments. It takes a few months or even years to recover, but the interventions can help.

Non-invasive options

The initial treatment methods for managing frozen shoulder are mostly noninvasive. These methods help reduce pain and swelling and, over time, increase the flexibility of the affected joint.

• Hot and cold compresses

Hot and cold compresses are thus two of the most basic yet effective ways of reducing frozen shoulder pain. Heat can also be applied in the affected area to relax muscles and ease stretching exercises through increased blood flow. Cold compresses effectively relieve inflammation and remove sharp pain caused by exercise. Applying the hot and cold treatment can be balanced and thus more effective in handling daily pains and discomforts.

• Medicines That Reduce Pain And Swelling

Anti-inflammatory drugs and other treatment procedures are prescribed to lessen inflammation and pain. Paracetamol or other non-steroidal anti-inflammatory drugs, such as Ibuprofen, can manage mild to moderate pain.

If your pain is severe, your doctor may prescribe stronger medicines, such as corticosteroids, in tablet form or as an injection into the affected joint.

• Physical Therapy

Physical therapy is a major component of managing frozen shoulder. A licensed physical therapist will then take you through several exercises to stretch and strengthen shoulder muscles and gradually increase the joint's flexibility.

At first, it may be painful or at least stiff, but these exercises are necessary to release the adhesions within the joint capsule that limit motion. The exercises will also change as you continue with the treatment to make the treatment process dynamic.

• A Home Exercise Program

An example of a home exercise program is an extension of the physical therapy program that you undergo. It enables you to practice the exercises for the shoulders even when you are not in the clinic. Home exercises are done regularly, and they go a long way in speeding up the recovery process and ensuring that the shoulder does not seize up again. Your physical therapist will give you a list of exercises you should do at home to supplement the treatment plans and ensure they align with the therapist’s objectives.

• Transcutaneous Electrical Nerve Stimulation (TENS)

Another non-pharmacological method, which is also non-invasive, is transcutaneous electrical nerve stimulation (TENS), which can also help to ease the pain associated with frozen shoulder. TENS is a technique of using low-voltage electrical currents to stimulate the nerves of the affected area, thus preventing the pain signals from getting to the brain. It is not addictive and does not involve medications. Though it will not help increase your shoulder’s range of motion, it makes other therapies, including physiotherapy, more comfortable.

Invasive Options

Non-invasive management may sometimes be insufficient, especially when shoulder joint function remains poor after several months of conservative measures. In such cases, invasive procedures can loosen the joint capsule and restore its function.

• Manipulation Under Anesthesia

Advanced frozen shoulder is best treated by manipulation under anesthesia (MUA), which is done more frequently than any other procedure. In this process, the physician administers general anesthesia so the patient cannot feel the pain. During sleep, your doctor will manipulate your shoulder in a manner that will attempt to tear the scar tissue that has developed within the joint capsule.

This procedure can be highly effective in increasing the range of motion of the affected limb, but intense physical therapy is normally required to retain the manipulation's results.

• Shoulder Arthroscopy

The other surgical intervention is the shoulder arthroscopy, which is done if MUA has not worked or where there is fear that the shoulder structures may be damaged through manipulation.

Arthroscopy is a keyhole surgery in which a surgeon puts a narrow instrument, known as an arthroscope, into the shoulder joint. This enables the surgeon to see and then free the tight regions of the capsular.

Compared to open surgery, the procedure leads to low pain and a short hospital stay.

Preventing Frozen Shoulder

Preventing frozen shoulder is a challenge, mainly because the condition's exact cause is not fully understood. However, there are steps you can take to reduce your risk, especially if you fall into one of the high-risk categories, such as having diabetes or having experienced a shoulder injury. These steps are:

1. Staying active and maintaining regular shoulder movement. The risk of developing a frozen shoulder increases when that shoulder motion is restricted for an extended period—due to injury, surgery, or simply inactivity. After surgery or suffering an injury that limits your shoulder's movement, start gentle range-of-motion exercises as soon as it is safe. These exercises help keep the joint flexible and can prevent the thickening of the joint capsule.

2. Seek medical help as soon as there are adhesive capsulitis symptoms. Consult a physical therapist who can create an individualized program to help you maintain your shoulder’s flexibility.

3. Proper management of other illnesses. For example, maintaining a good blood sugar level for those with diabetes lowers your chances of getting the disease.

4. Proper ergonomics in daily activities. It is advisable to avoid putting too much pressure on your shoulders during everyday activities. This entails avoiding postures that may cause pressure on the joint, such as sitting, lifting, and carrying objects that cause stress on the shoulder joint. Taking breaks and stretching the shoulders during the day will help prevent the shoulders from getting stiff.

Find a Qualified Physical Therapist Near Me

When you are struggling with the stiffness and pain of a frozen shoulder, you want to consult a physical therapist. At Suarez Physical Therapy in Las Vegas, you receive compassionate physiotherapy tailored to treat your condition. We know your challenges and are dedicated to treating you until you can perform your daily activities. Contact us at 702-368-6778 to schedule your consultation and begin your frozen shoulder treatment.