Frozen Shoulder Syndrome (Adhesive Capsulitis)
Treating Frozen Shoulder - Maureen Abson
What is Frozen Shoulder?
Frozen Shoulder Syndrome (FSS) is among the most severe, painful and debilitating shoulder conditions. It is fairly common and rarely the result of an underlying illness or pathology. Frozen Shoulder affects as many as 2-5% of the population.
Experts define frozen shoulder as "a stiff shoulder with less than 50% of normal range of active and passive motion in any direction". Although it is fairly common, one of the main problems is that frozen shoulder is often misdiagnosed.
The causes of frozen shoulder syndrome are still poorly understood. About 50% seem to stem from an injury to the shoulder (such as a fall on an outstretched arm) and these are called secondary frozen shoulders.
But 50% of the time they appear for no apparent reason, and these are called primary frozen shoulders.
The natural history of this condition is well documented. Over the course of (typically) 30 months the frozen shoulder passes through three phases: freezing, frozen and thawing.
Phase 1 - Freezing
The freezing (painful) phase lasts between three and eight months. Severe night pain is a common feature of this phase. Clients often complain that they are unable to sleep on the affected side. If they do manage to drift off, they are soon awoken in agony.
Many clients find that they are re-arranging pillows to support the arm and that they must ‘steal’ sleep where they can.
The pain itself can be quite horrendous. Clients usually describe three types of pain:1. A constant ‘internal’ dull burning
2. Pain down the outside of the upper arm
3. Severe sharp catching pain after certain innocuous movements lasting up to two minutes
Clients usually report pain when brushing the hair, doing up the bra, or reaching behind themselves.
Along with this there can often be rapid stiffening of the whole shoulder.
Phase 2 - Frozen
This is followed by the frozen (stiff) phase, which lasts between four and 12 months. There may still be night pain but this usually diminishes as shoulder mobility decreases. Here patients are usually able to sleep but find it increasingly difficult to perform daily chores.
This is especially so for those poor people who are affected on both sides. So many of the menial tasks we thoughtlessly perform become titanic achievements. I have had several female clients who have taken to wearing wigs, as they are unable to do their hair.
During this second phase, pain can often radiate into the forearm or hand, and in some cases the hand can become swollen and painful. In some cases this may be due to the onset of a condition called reflex sympathetic dystrophy (RSD).
In other cases the pain may also start at the back of the shoulder in the region of the triceps muscle. This is typically due to a triceps tendonitis.
Phase 3 - Thawing
Spontaneous recovery of mobility (thawing) follows over the next four to 12 months, although full recovery is commonly protracted.
Occasionally clients may awake after 18 months to find they are fully better, but in my experience this is rare. Without treatment, even after the thawing phase a restriction of mobility may often persist for several years.
It is worth noting that some experts talk of a ‘pre- adhesive’ stage, before the freezing phase begins. Here patients present with signs and symptoms of what is commonly termed ‘impingement syndrome’.
This is where there is still movement but there is a catching in certain positions. The only signs that there is a frozen shoulder would be if a camera were placed within the joint (arthroscopy). This often reveals some reddening of the synovial capsule and an increase in thickening of the capsule, indicating the onset of a frozen shoulder.
Who is Prone to Frozen Shoulder?
Frozen shoulder affects slightly more females than males typically between 40 and 60 years of age. The non-dominant arm (i.e. left arm in most people) is more likely to be involved, although about 12% of people are affected on both sides (bilaterally).
Frozen shoulder syndrome is much more common in diabetics, affecting between 10 and 20%. It lasts for an average of 30 months, although one recently published study showed that up to 60% of sufferers still had some symptoms after 10 years.
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