Often called a stiff or “frozen shoulder,” adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. It affects women more than men and is typically diagnosed in people over the age of 45.
The actual cause of adhesive capsulitis is not completely understood. Some believe it is caused by inflammation, or by autoimmune reactions, where the body launches an “attack” against its own substances and tissues. Other possible causes include, reactions after an injury or surgery. Pain from other conditions, such as arthritis, a rotator cuff tear, bursitis, or tendinitis, that has caused a person to stop moving the shoulder may lead to frozen shoulder. In addition, immobilization of the arm, such as in a sling, after surgery or fracture have been associated with frozen shoulder. However, in many cases there is no clear reason why adhesive capsulitis develops.
Most people with adhesive capsulitis have worsening pain and a loss of movement. Adhesive capsulitis can be broken down into 4 stages:
Stage 1: “Prefreezing”
During stage 1, it may be difficult to identify your problem as adhesive capsulitis. You’ve had symptoms for 1 to 3 months, and they’re getting worse. Movement of the shoulder causes pain. It usually aches when you’re not using it, but the pain increases and becomes “sharp” with movement. You’ll begin to limit shoulder motion during this period and protect the shoulder by using it less. The movement loss is most noticeable in “external rotation” (e.g. reaching your arm behind your neck), but you might start to lose motion when you raise your arm or reach behind your back. Pain is the hallmark feature of this stage; you may experience pain during the day and at night.
Stage 2: “Freezing”
By this stage, you’ve had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain. The shoulder is especially painful at night. The shoulder still has some range of movement, but it is limited by both pain and stiffness.
Stage 3: “Frozen”
Your symptoms have persisted for 9 to 14 months, and you have a greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder to end range.
Stage 4: “Thawing”
You’ve had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is steadily improving.
In our office, we diagnose frozen shoulder through a series of clinical tests. We will look for a specific pattern of motion called a “capsular pattern” that is typical with adhesive capsulitis. In addition, we consider other conditions, such as diabetes, thyroid disorders, and autoimmune disorders, that are associated with adhesive capsulitis.
Once we diagnose a frozen shoulder, our first recommendation is usually to take a short break from activity that results in sharp pain. However, we caution against complete rest because this may lead to muscle atrophy and worsening of symptoms.
Relative rest, however, allows for an environment for the inflammation to settle down and the joint capsule to heal. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of the issue.
In many cases, frozen shouder are coupled with poor mobility of the lats t-spine and neck. This can be combined with weakness of the rotator cuff and the lat muscles. In addition, if there are imbalances at the core and hip muscles, the way an active person moves can be affected which may lead to faulty shoulder mechanics. However, the only way to know what is contributing to pain and injury is to perform a complete assessment.
When pain and stiffness is found via the assessment, our approach includes manual mobilization to alleviate pain and improve mobility. Targeted stretching within a reasonable pain tolerance helps restore mobility. If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Once pain is controlled and muscles engage better, our next step is teaching our patients to develop stability of the shoulder girdle with resistance. We know for the shoulder to become durable at less prone to future injury, proper movement must be taught and a well designed strength and conditioning program must be initiated.
When addressed with a through physical therapy assessment and plan of care, frozen shoulder is a condition that can resolve completely. However, ignoring symptoms and moving with poor mechanics can develop into a more serious problem. If you feel like you may be developing frozen shoulder, the physical therapists at Movement Solutions would be glad to be a resource for you. We can begin the process with a free 15-minute phone consultation to talk about how your shoulder is affecting you. If your concerns warrant an in-person consultation, we offer a free Discovery Visit. This gives us the opportunity to examine your injury, provide you clarity about your condition, and instill confidence that we can help. Call us today at (864)-558-7346 and ask us how we can get you back to your active way of life.