Frozen Shoulder symptoms, causes and treatment

By the time you read this, the chances are you are in pain and have probably seen a therapist who hasn’t helped you much. Worse, you may have had injections or surgery which may also have failed to make a difference! The fact is that shoulder pain affects one in five people at one time or another in their lives. Pain often starts with a small injury that gets worse but can sometimes come-on suddenly. Once established it impacts on almost every aspect of your life; from dressing to sleeping it can even cause depression.

Frozen shoulder (Adhesive Capsulitis) is a common condition that affects the ability to move the shoulder. It causes stiffness and pain in the shoulder, which reduces normal movement in the joint. In some cases, it can prevent movement in the shoulder altogether.

Frozen Shoulder Facts:

• Affects 2-5% of the population.
• It is more common in women (60%).
• It is five times more common in diabetics.
• It is more common in patients with Dupytren’s contracture.
• It may have a genetic component i.e./ it can run in the family.
• It may well have an auto-immune component.
• It seems to affect 40-70 year olds.
• About 15% of people get it in both shoulders.

How long does it last for?
Symptoms lasts an average of thirty months (some say longer).

There are three phases to frozen shoulder:
Freezing: the shoulder starts to ache and feel stiff, before becoming very painful. The pain is often worse at night and when you lie on the affected side. This stage lasts between 1-8 months.
Frozen: this is known as the adhesive stage. The shoulder typically becomes increasingly stiff, although the pain does not normally get worse. The muscles may start to waste slightly as they are not being used. This stage lasts between 9-16 months.
Thawing: this is the recovery stage in which you gradually regain movement of the shoulder. The pain also fades, although it may recur from time to time as the stiffness eases. Although it is possible that you may not regain full movement of your shoulder, you will be able to do many more tasks. This stage can last any period of time from twelve months to 3-4 years.

What is happening inside my frozen Shoulder?
Inflammation
In a Frozen Shoulder Syndrome the lax shoulder capsular sack becomes sticky and can sometimes form adhesions; hence the name of the condition. The stickiness is brought on through inflammation; this can occur after a small injury, like reaching for the back seat of the car, but often you may not remember anything. Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae).

Stiffness
The stiffness is an ‘overreaction’ to the inflammation. The body seems to ‘switch off’ muscles in a co-ordinated sequence; this sequence is the same for everyone and we call it the ‘capsular pattern’. In less than a week the arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, can not be raised more than 40° in any direction. The muscles of the rotator cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.

Our approach
Traditional approaches to the frozen shoulder either address the inflammation (steroid tablets, steroid injections and hydrodilatation) or the stiffness (physical therapy, exercise therapy and surgical manipulation). Physical therapies attempt to improve the range of motion by forcing the shoulder through the blockage; this in our opinion can make things considerably worse.

At Back Pain Centre Sunderland our practitioners use the Niel-Asher Technique to treat Frozen shoulders. The technique works by reducing inflammation and re-programming the muscles which have switched off. We keep the arm still whilst we apply a sequence of pressure points to specific tissues. The treatment can still be painful, especially in the early ‘Freezing phase’, but it is no worse than the pain of the Frozen shoulder. The first few sessions primarily address the inflammation, after this the emphasis is on improving the range of motion. Depending how long you have had the problem and which phase you are in, results can be seen in as few as 4 sessions (range 4 –13). The results can be dramatic and fast and the method is ‘totally natural’. We believe it should be the first line of treatment before injections and or surgery.

The information provided is for general guidance only and must not be used for diagnosis or treatment of a health problem. This information is not intended to be a substitute for professional medical advice.