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 frozen shoulder 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 a frozen shoulder. In addition, immobilization of the arm, such as in a sling, after surgery or fracture has been associated with a frozen shoulder. However, in many cases, there is no clear reason why a frozen shoulder develops.
Most people with a frozen shoulder have worsening pain and a loss of movement. Frozen shoulder can be broken down into 4 stages:
Stage 1: "Prefreezing"
During stage 1, it may be difficult to identify your problem as a frozen shoulder. 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 and 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 the 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.
Frozen shoulder can be diagnosed through a series of clinical tests. There is a loss of motion (called a "capsular pattern") that is typical with adhesive capsulitis. This may coincide with other conditions, such as diabetes, thyroid disorders, and autoimmune disorders.
Once a frozen shoulder is diagnosed, the first common-sense recommendation is to take a break from any activity that results in sharp pain. However, it is recommended to avoid complete rest because this may lead to muscle loss and worsening of symptoms.
Relative rest, however, allows for irritation to settle down and pain to subside. If pain persists, hands-on therapy can be helpful to bring pain to a manageable level. Once the pain subsides, you can work on other regions of the upper body and trunk which will enable a better recovery as the frozen shoulder thaws.
In many cases, frozen shoulder is coupled with poor mobility of the shoulder muscles, upper back, and neck. This can be combined with weakness of muscles that stabilize the shoulder. The best way to know what regions to focus on is to have an assessment performed.
Range of motion exercises within a reasonable pain tolerance can help improve mobility. Exercises like a supine pullover and a wall walk can be effective early on.
If there is weakness, learning how to activate muscles that are not firing well is key. Prone I's, T's, and Y's and side-lying shoulder rotations are good exercises for activating key shoulder muscles (i.e. lats and rotator cuff).
Once muscles engage better, the next step is learning how to generate tension in these key muscles while performing strength training exercises. Exercises like the kettlebell armbar and Turkish get-up can be powerful during the later stages of frozen shoulder rehabilitation.
Most of the aforementioned exercises can be found in our video library.
When addressed with a specialized physical therapy program, overcoming a frozen shoulder is possible. However, ignoring pain and engaging in repetitive activity can create a more serious shoulder condition. If you have concerns about a frozen shoulder, the physical therapists at Movement Solutions would be glad to be a resource for you.
We offer a free guide on relieving shoulder pain that can give you further insight into shoulder problems and help kickstart your recovery.
If you want help, you can request a shoulder consultation with one of our specialists. This is an opportunity to ask questions, obtain clarity about your shoulder pain, and foster confidence that we can help you. If you’re certain that we’re a good fit to work together, you can decide on the next step.
If you’re in pain but unsure about what you should do, call us at (864) 558-7346 and ask how we can help.