A Frozen Shoulder is an inflammatory condition of the Glenohumeral Joint Capsule that results in the gradual but consistent loss in range of motion, usually not stopping until shoulder range is significantly reduced. This loss in range of motion is due to the physical thickening of a portion of the glenohumeral joint capsule and ligaments. Patients with frozen shoulders generally report increased symptoms at night and commonly have difficulty performing any tasks that require arms overhead or behind their back due to pain and reduced mobility. Research reports that frozen shoulders progress through three overlapping phases:
1. Freezing (Painful) Phase: This phase is marked by inflammation and a contracture of the joint capsule/ligaments, causing a gradual onset of shoulder pain at rest with extreme, sharp pain at end range of motion.
2. Frozen (Stiffening) Phase: Progressive loss of Glenohumeral Joint range of motion. Pain at rest subsides but pain is still present at end range of motion
3. Thawing (Resolution) Phase: Gradual (sometimes spontaneous) improvement in functional range of motion. Pain may still be present at the end range.
Frozen shoulders are largely unique in the fact that they are not the result of the traumatic injury. Instead, they behave more like a disease with certain people being more at risk than others due to genetics, environmental factors or just bad luck. Frozen shoulders affect between 2-5% of the general population, with about 70% of cases being found in women between the ages of 35-65. Current research suggests that individuals with diabetes are at the highest risk of developing a frozen shoulder with a prevalence of nearly 20%. Other high risk groups include those with previous shoulder injuries, Parkinson's Disease, a Thyroid Disorder, a history of cancer or stroke and more.
Treatment is essential for a frozen shoulder as this is not a condition that will resolve on its own. Frozen shoulders have been documented to last over 10 years with little to no improvement in symptoms when ignored. However, treatment for frozen shoulder is difficult because it is dependent on the causative factors (discussed above) as well as the phase of the condition. For example, treatment during the “freezing” phase will be focused on symptom relief to lower pain levels and help the patient get back to sleeping. Depending on individual factors, treatment may include lifestyle modification such as an anti-inflammatory diet and exercise. While treatment in the “stiffening” phase will likely consist of more manually guided end-range stretching, mobilization, soft tissue treatment (i.e. Functional Range Release, Active Release Therapy, Massage), and specific home exercises targeted at the portions of the joint capsule and ligaments that have become “frozen” and restricted. Unfortunately, having a frozen shoulder may result in other areas of the body compensating for an overly stiff shoulder. As a result, patients often benefit from treatment to ease pain and tightness of the neck and upper back.
Frozen shoulder is a self limiting disorder of approximately 15-18 months. Steroid and careful stretch techniques are the mainstay of treatment, not misinformation.