Also known as adhesive capsulitis, contracted shoulder or pitcher’s arm, is an extremely painful condition where the shoulder is partially or completely stiff and unmovable, affecting your ability to carry out everyday activities such as bathing, dressing, driving and sleeping comfortably.
It usually comes on gradually, gets worse over a number of months and may improve with time, though can take several years. It is most common between ages 40-60, particularly in women.
The shoulder is a ball and socket joint; the end of the upper arm bone (humerus) sits in the socket of the shoulder blade (scapula). The lining of the shoulder joint, the capsule, is a flexible elastic structure allowing the shoulder’s huge range of motion. It is fully stretched when you raise your arm above your head and hangs down as a small pouch when the arm is lowered. In frozen shoulder this capsule and its ligaments becomes inflamed, swollen, thickened and contracted; normal elasticity is lost and there is less space for your upper arm bone in the joint. Pain and stiffness set in. The rotator cuff is a group of four muscles that control shoulder movements: supraspinatus, infraspinatus, teres minor, subscapularis.
Can vary from mild with little effect on daily activities to severe and possibly unable to move the shoulder at all.
Stage 1: Freezing: shoulder starts to ache and can be painful on reaching out; often worse at night laying on affected shoulder. Can last 2-9 months.
Stage 2: Frozen: increasing stiffness, pain decreases, range of motion more limited. Shoulder muscles may waste from lack of use. Can last 4-12 months.
Stage 3: Thawing: gradually regaining movement, though not fully, pain reduces and able to do more tasks. Can last 12-42 months.
Each person’s symptoms and causes may be slightly different, making it difficult to say what has caused the problem. Exact cause is unknown; may be caused by inflammation of shoulder joint and surrounding capsule, may lead to thick scar-like tissue forming in the capsule making it tight and restricting movement of the joint. It can develop alongside calcific tendonitis: where small amounts of calcium are deposited in the tendons of the shoulder or rotator cuff tear.
Risk factors include breast cancer, diabetes, heart disease, high cholesterol, stroke, thyroid disease, recent shoulder injury, fracture or surgery, lack of use, Dupuytrens contracture.
A medical practitioner will ask about symptoms and injuries that may have affected the shoulder, its effect on daily life and sleep, severity of pain and what affects pain; also related pains, other health conditions and medication you are taking. Examination of range of motion, moving shoulder in all directions compared with unaffected shoulder; pressure to parts of shoulder to determine where pain is most severe and what is causing it; look for swelling, bruising or muscle wasting. X-ray, ultrasound scan and MRI may be used to rule out other causes of pain such as rotator cuff tear or arthritis.
Physical therapy, pain killers, anti-inflammatories, corticosteroid injections, Arthroscopic Hydrodilatation under local anaesthetic: filling shoulder joint with fluid to break up scar tissue and free up the joint is more effective than simple injections, surgery: arthroscopic Capsular Release or Manipulation Under Anaesthetic.
Massage, manipulation, myofascial techniques on joint and soft tissues, stretching and strengthening, trigger point therapy, dry needling, strapping, home rehabilitation exercises, attention to postural and sleeping habits.
We are happy to advise you on your health matters and offer a free 15 minute joint and spinal check, without obligation.