A frozen shoulder is long term shoulder problem that is not caused by cold despite its name. The term frozen shoulder simply means that movement at the shoulder joint is restricted and usually painful. It affects about 3 in 100 people at some point in their life and women in the 40 to 60 age group tend to be at the highest risk. A frozen shoulder can take anywhere between 18 months to 3 years to resolve although most cases resolve within 2 years.
A frozen shoulder is known medically as adhesive capsulitis. This refers to the capsule of the shoulder joint. It should not be confused with the various types of arthritis. Frozen shoulder is a separate condition from arthritis.
What Happens In A Frozen Shoulder
The shoulder joint is surrounded by a capsule. This is a thick connective tissue that protects the joint and provides both support and stability. It firmy surrounds the bones, tendons and ligaments of the shoulder joint but still allows movement in order for the shoulder joint to function. However, the capsule can be a problem for shoulder movement if it tightens sround the joint.
This is what happens in a frozen shoulder. The capsule thickens and tightens around the shoulder joint. It appears the tissue of the shoulder joint capsule becomes inflamed. Swelling and pain are features of inflammation. There may be some scar tissue formation and this further thickens and restricts the contents within the joint. However, the cause of these changes is still not fully understood.
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It is believed that there may be some disturbance in immune activity leading to inflammation and abnormal tissue formation in the capsule. A frozen shoulder develops gradually and persists for long periods of time, at least 18 months. There is usually no significant long term complications. The pain and stiffness can restrict daily functioning and affect a person’s independence which can also impact mental health.
How To Spot A Frozen Shoulder
It is important that shoulder symptoms are assessed by a medical professional in order for a frozen shoulder to be diagnosed. The initial symptoms may not only be seen in a frozen shoulder. These non-specific shoulder symptoms like pain and stiffness can ocur in many other shoulder conditions. Some of these conditions are more common than a frozen shoulder, like osteoarthritis of the shoulder.
However, when it arises in the backdrop of previous shoulder problems then a frozen shoulder should be strongly suspected as a possible cause of the symptoms. This applies to any previous shoulder problem where the mobility of the shoulder joint is restricted for long periods of time. Nevertheless diagnostic investigations like an x-ray or MRI (magnetic resonance imaging) should be conducted to exclude other possible causes.
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Pain in the Shoulder
Shoulder pain develops gradually and is typically a dull ache. It can be vague at the onset and many people mistaken this pain for shoulder injury or strain. The pain is also described as nagging and can disturb sleep. Most people are unable to sleep on the affected side and it can even lead to sleep deprivation. Apart from worsening at night, the pain also tends to worsen with movement.
It is not uncommon for people to use pain as a means to assess whether the condition is worsening or resolving. However, this can be unreliable. Pain arises in the first stage (freezing stage) of frozen shoulder. It can peak during this stage and diminish during the frozen stage. Even with less pain, the condition has not resolved and can still persist for up to another 2 years (frozen stage + thawing stage).
Tenderness at Shoulder Joint
Tenderness is typically present is frozen shoulder. This is where the pain is triggered or worsens when pressure is applied to the affected area. The tenderness is usually detectable at the insertion of the deltoid muscle. It can also be felt at the front and back of the shoulder with deep pressure. However, it is important to differentiate tenderness due to other causes as there are several musculoskeletal structures that can cause a dull achy pain in this region.
Limited Range of Motion
Movement at the shoulder joint is limited. This means that movement can still occur but not within the same range of motion as normal. This may be seen in everyday activities when a person cannot scratch their back or put on a shirt or coat without assistance. The ability to reach over the head, to the sides or across the with the arm of the affected shoulder joint is typically affected. Not only is movement difficult (stiffness), the arm cannot move to the same positions and to the same extent as would normally be possible.
Stiffness at Shoulder Joint
Movement is not just limited through its range of motion. It is also difficult to move. Pain is a factor but the restriction is a result of the thickening of the capsule joint which occurs in frozen shoulder. This causes a tightening round the shoulder joint. Therefore movement may be difficult even within the possible range of motion. The stiffness persists in the first two stages (freezing and frozen stages) and only begins to improve in the third stage (thawing stage).
History of Shoulder Problems
There are several risk factors for developing a frozen shoulder. This includes age (being older than 40), gender (women are at greater risk), diabetes, thyroid problems (over- and underactive thyroid), Parkinson’s disease and certain medication (particularly some HIV drugs). However, these are not shoulder-specific risk factors and may not require preventative measures to avoid a frozen shoulder from arising.
Certain shoulder and arm problems increases the risk of a frozen shoulder. This includes a fractured arm, rotator cuff injury as well as a stroke and prolonged recovery after surgery. The common factor in all of these shoulder-related risks is that shoulder movement is restricted. Physical therapy and certain exercises may therefore be advisable for people with these risk factors to possibly prevent a frozen shoulder in the future.