Occasionally, I hear the term "frozen shoulder" from patients as they self-diagnose a shoulder that hurts and has limited movement.
However, there are certain characteristics that distinguish frozen shoulder from other types of shoulder injury that may result in soreness or restricted movement.
The medical term for frozen shoulder is "shoulder adhesive capsulitis," a condition that affects about two per cent of the general population from 40 to 75 years of age. It is found more commonly in women (70 per cent) and has been shown to be correlated with diabetes, hypothyroidism, stroke, heart attack and sedentary occupations.
Frozen shoulder is characterized by a progressive and painful loss of movement.
It can be caused by repetitive overuse tendon injury, which can occur when working with your arms above your head for prolonged periods; a trauma that results in prolonged immobilization such as a broken arm; or even a consequence of a cardiac or neurological episode such as heart attack or stroke.
Common characteristics of a frozen shoulder include pain at night, discomfort lying on the affected side and loss of movement at the shoulder. A unique movement limitation pattern found in frozen shoulder follows what is known as a "capsular pattern," which is a sequence of movements that indicate the problem is inside the joint. Those with frozen shoulder will also have marked reduction in all movements, especially rotating the arm to perform tasks such as throwing a Frisbee or making a snow angel motion.
How do you know if you have a frozen shoulder?
Those dealing with this condition may describe their symptoms quite differently depending on which of the four stages of frozen shoulder they are in.
The first stage is the onset of symptoms, where it hurts to move your shoulder and the capsular pattern is starting to become noticeable. Typical complaints are pain with movements such as reaching into the back seat, of the car, opening doors or throwing a Frisbee.
The second stage is known as the adhesion stage, which develops about three months after the onset of pain. Common complaints here are shoulder pain radiating to the elbow, muscle spasms and more significant loss of shoulder movement.
The third stage is the frozen stage, where pain is less overall but the shoulder feels very stiff and there is limited movement. A sore or tight neck is common at this stage as the shoulder begins to hike. That is a compensatory movement in which the neck muscles are used to pull the arm up to adapt for the lack of movement in the shoulder joint.
The fourth stage is the "thawing" stage, where there is a slow and steady recovery from the loss of motion. The progression through the stages varies for each individual and studies have shown that recovery can take from two to three years, depending on when a diagnosis is made.
In other words, early detection and treatment before the end of the first stage is key. Once the shoulder starts to adhere in the second stage, treatment — be it physiotherapy, massage, chiropractic or local injections by physicians — is not as effective. If you leave it too long, chances are you will have to let the condition run its course and begin rehabilitation in the last thawing stage to help restore mobility, strength and function.
Of course, the best way to treat a frozen shoulder is to avoid getting the condition at all.
If you consistently are noticing a nagging shoulder, don’t wait three or four months to get it checked out. If you sustain an injury that results in six to eight weeks in a sling, move that shoulder as soon as your doctor indicates that it is appropriate. If it is painful to move, consult with a physiotherapist or other health care practitioner for guidance in restoring mobility, strength, stability and function.
Carmen Lee is a physiotherapist with the Winnipeg Regional Health Authority’s Pan Am Clinic.