11. 'Frozen Shoulder'

'Frozen shoulder' is sometimes used as a generalised term for shoulder problems that are very restricted and painful in their movements. The most commonly associated term that healthcare professionals associate with 'frozen shoulder' is adhesive capsulitis.

Description of 'Frozen Shoulder'

For me, 'frozen shoulder' is adhesive capsulitis, secondary to any other shoulder dysfunction that causes limitation and eventually a fibrosing (thickening) of the shoulder capsule surrounding the main shoulder 'ball' joint (the gleno-humeral joint).

The best description I give to my patients is asking them to imagine the shoulder capsule looking like Cling-Film folding onto itself. (If this has ever happened to you, you will understand how difficult it is to peel the surfaces apart cleanly without causing damage to the Cling-Film.)

Normally when you lift your arm upwards, your armpit stretches to allow you to move - imagine if the folds of the capsule inside your armpit are painfully swollen or stuck together like Cling-Film and then you can see why the shoulder has problems moving in different directions.

Left untreated, this condition can take 18 months to three years to settle down. By this time, the shoulder is chronically restricted.

The Three Phases of a 'Frozen Shoulder'.

Phase 1 - Pain (6-12 months)

Painful restriction of most movements.

Phase 2 - Stiffness (6-12 months)

Very restricted range of most movements, but with less pain.

Phase 3 - Recovery (6-12 months)

Some increase in movement around the shoulder girdle, but the gleno-humeral joint is chronically stiff.

Treatment Options

The treatment protocol for 'frozen shoulder' is difficult and varied, depending on the original cause of shoulder pain. In theory, almost any shoulder problem could lead to a 'frozen shoulder'.

Conditions such as an acute tendinitis, bursitis or muscle strain can be dealt with very effectively if caught early on, i.e. less than 6 weeks, but preferably less than 2 weeks.

If the cause is of a chronic degenerative nature, either of the joints or rotator cuff tendons, this can be a lot trickier, as degeneration cannot be reversed, only managed. However, effective osteopathic management of a degenerating shoulder can also give much relief and restoration of movement if realistic goals are set at the beginning of treatment.

The types of osteopathic treatment used can vary from gentle to painful depending on the patient and the type of restriction (just remember that it is not an osteopath's goal to create pain just for the sake of it).

An understanding, motivated and co-operative patient makes a huge difference, as there is nothing more frustrating for me than when a patient says to me after 4 sessions in the first month that, 'it is not completely cured yet!' Remember, we're trying to sort this out in a time shorter than 18 months to 3 years.

In tricky or unresponsive cases, steroid injections from doctors can occasionally help, but my experience has been that this should be tried only after unsuccessful manual treatments, as if there is a structural problem, no injection or magic pill is going to make a long-term difference. Even after an injection, manual treatment should be sought about two weeks later to take care of any chronic adaptations and to ensure that the injected tissue does not become the same problem again a few months or years later.

In extreme examples, a manipulation under anaesthetic (MUA) by an orthopaedic surgeon is required. This is simply the surgeon taking the shoulder and forcing it to its normal range of motion and in the process breaking all of the fibrous adhesions around the shoulder capsule.

In some cases, however, the shoulder capsule is so fibrotic that the adhesions are stronger than the bone. Consequently, a forceful MUA can result in a fractured humerus (upper arm bone), especially in elderly women whom have osteoporosis.

Conclusion

If you have a painful restricted shoulder, there is a possibilty that it could become a long-term chronic problem ... but of course it might not. See someone about it sooner rather than later.

Shoulder movement is a privilege, not a right - move it or lose it.

* The image of the shoulder joint contained within this article is taken from Gray's Anatomy. This is a view from the front of the right shoulder and the capsule is the blue area. Please note that this capsule is DISTENDED and normally it more closely follows the joint line when healthy.