Frozen shoulder, medically known as “adhesive capsulitis,” is a prevalent condition affecting approximately 3 to 5 percent of the general population. Its main characteristics include shoulder pain accompanied by limited range of motion. The term “adhesive” refers to stickiness, while “capsulitis” signifies inflammation of the protective layer called the “capsule.” This capsule is a natural anatomical structure resembling a cellophane-like membrane. It serves as a thin, flexible, and spacious covering that envelops the shoulder joint for protection.
Essentially, frozen shoulder occurs when this protective capsule surrounding the shoulder joint becomes inflamed, causing it to swell, thicken, and contract. Consequently, the once thin and supple structure becomes sticky, leading to restricted shoulder mobility. The inflammation induces pain, while the contracted capsule limits the movement of the shoulder.
The inflammatory process that results in the swelling, thickening, and contraction of the capsule often occurs without any apparent cause. However, certain factors can increase the likelihood of developing frozen shoulder, including genetic predisposition. This condition primarily affects individuals between the ages of 40 and 65, with women being four times more likely to be affected than men. Additionally, individuals with thyroid disease, autoimmune diseases, stroke, heart attack, Dupuytren’s disease, Parkinson’s disease, or those who experience prolonged immobilization following a shoulder injury or surgery are at a higher risk. Approximately 10% to 20% of people with diabetes are also susceptible to developing frozen shoulder. In some cases, younger individuals, both male and female, may develop frozen shoulder spontaneously without any identifiable triggering causes.
Frozen shoulder generally presents itself in three stages. In the initial stage, known as the inflammatory stage, frozen shoulder is characterized by pain resulting from the onset of inflammation. Initially, the pain is predominantly experienced during active shoulder movements. However, as this stage progresses, the pain intensifies and may be present even when the shoulder is at rest. Nighttime can be particularly uncomfortable, as the pain may worsen during sleep.
During this stage, which can last from 6 weeks to 9 months, it is common for patients to instinctively respond to the shoulder discomfort by immobilizing it using a sling and avoiding shoulder movement due to the pain. Initially, resting and reducing activity may provide some relief from the pain. Paradoxically, this shoulder immobilization is counterproductive. Restricting shoulder movement exacerbates the problem by further allowing the inflamed capsule to further shrink surrounding the shoulder joint, constricting it like a tightened leather bag, and consequently further restricting shoulder motion.
The second stage, known as the “frozen stage,” occurs after the inflammation has subsided, resulting in a notable reduction in shoulder pain. However, during this stage, the shoulder experiences a significant loss of range of motion, ranging from mild limitations of just a few degrees to severe cases where there is no motion at all. Any attempts to move the shoulder, whether passively or actively, would be impossible beyond that limited zone of motion. This stage can persist for a duration of approximately 4 months to one year.
In the third and final stage, the shoulder undergoes a gradual “thawing out” process over a period of 6 months to two years, resulting in spontaneous improvement in the range of motion. Remarkably, even without any specific treatment, the range of motion and usability of the shoulder gradually improve over time, although the progress may be slow. It typically takes around two years for a full or nearly full recovery to be achieved.
The diagnosis of frozen shoulder is primarily established through a combination of medical history and physical examination. The presence of shoulder stiffness and pain, without any other underlying causes like arthritis or calcific tendonitis, suggests the likelihood of frozen shoulder. X-rays are typically uninformative in confirming the diagnosis. However, a definitive confirmatory test, such as an MRI, can be obtained. This imaging technique reveals a significantly thickened shoulder joint capsule, further supporting the diagnosis of frozen shoulder in the absence of other shoulder pathologies.
The management of frozen shoulder, a potentially debilitating condition that can persist for months to years, requires early diagnosis and intervention. In the initial stage of inflammation, various local modalities can be employed to promote improved circulation and relaxation of the surrounding soft tissue structures. This may include the use of warm packs, massages, and the judicious use of anti-inflammatory medications or limited corticosteroid injections to control the inflammation.
However, the key to achieving a successful and expedited outcome lies in early initiation of range of motion exercises. These exercises can be performed under the guidance of a physical therapist or individually with proper instructions. Early mobilization of the shoulder is crucial for preventing further stiffness and promoting recovery.
For cases that do not respond adequately to conservative measures over several months, more advanced management options may be considered. These options include shoulder manipulation performed by an orthopedic surgeon under anesthesia or surgical treatment using various techniques.
It is important to emphasize that early intervention and regular physical therapy play a vital role in the effective management of frozen shoulder, aiming to restore shoulder mobility and alleviate symptoms.
A novel device called ShoulderSphere® is gaining popularity among individuals who have a solid understanding of the underlying process of frozen shoulder and prefer to manage it independently. This innovative technique offers a unique approach to self-management.
Learn more about ShoulderSphere® for frozen shoulder conditions.
ShoulderSphere® utilizes a technique known as the “Balloon Inflation Technique.” This innovative approach involves performing rotational movements to achieve a gentle, circumferential, and symmetrical 360-degree stretch of the shoulder capsule. This stretching process mimics the gradual inflation of a balloon. Patients actively engage in these rotational motions as part of their self-management routine.
By utilizing the ShoulderSphere® and performing these rotational movements, not only does the shoulder capsule gradually stretch over time, but the rotator cuff muscles also become strengthened and educated to function as a cohesive unit. This improved coordination of the rotator cuff muscles contribute to better control and enhanced stability during shoulder movements.