One of the hallmark symptoms of frozen shoulder is exactly what you might expect given its name: the shoulder is “frozen”, meaning there is a loss of shoulder joint motion. Beyond that, this condition (also known as adhesive capsulitis…if you like technical terms) can sometimes be a difficult one to understand and treat. The prevalence of frozen shoulder varies significantly, ranging anywhere from 2% to 38% according to Kelley and colleagues. However, for those affected, it can be quite limiting. The intent of this post is to provide a quick guide to the diagnosis of frozen shoulder – the causes and risk factors, stages and symptoms, and what to expect during treatment. Ready? Let’s begin.
Causes of Frozen Shoulder
Frozen shoulder is classified into two subtypes, primary and secondary. Primary frozen shoulder is idiopathic, which means that there is no known cause, injury, or event that brings the condition on. Conversely, secondary frozen shoulder often results from a previous injury, such as a rotator cuff tear or fracture. Regardless of the subtype, frozen shoulder is most frequently seen in 40-65 year-olds and tends to be slightly more common in women. Other risk factors associated with this condition include diabetes, thyroid disease, and a previous history of frozen shoulder.
4 Stages of Frozen Shoulder
The two main symptoms that patients with frozen shoulder experience are loss of motion and pain. Though the course and severity of this condition will vary from person to person, it can typically be broken down into 4 stages.
Stage 1: During this stage, pain is felt at the end ranges of motion, i.e. lifting the arm high overhead or reaching far behind the back. The patient may also experience some pain at night.
Stage 2: This has been described as the “freezing stage”. The patient will have a further loss of motion, and movement of the affected shoulder can be quite painful.
Stage 3: At this point, shoulder joint motion is severely limited, however; pain may begin to subside. This stage is also known as the “frozen stage”.
Stage 4: In the “thawing stage”, pain will have decreased significantly, but residual stiffness of the affected shoulder may persist for several months.
The goals of treatment for patients with frozen shoulder depend heavily on what stage the patient is in. In earlier stages, the focus of treatment is to decrease pain, maintain mobility, and provide education regarding self-management and what to expect if the condition progresses. In stages 2 and 3, the aim is to regain the motion that has been lost. Your physical therapist may begin mobilizations and other manual therapy techniques in the clinic, as well as provide exercises and stretches for you to do at home. A word of caution, this is one diagnosis for which “no pain, no gain” does not apply. Pushing too hard, too fast can be detrimental and prolong recovery. Treatment during the final stage of frozen shoulder is all about restoring function. At this point, there should be minimal pain and motion should be returning gradually – allowing you to start getting back to doing the things you love.
Check out this article more information (warning: it’s long, but chock full of really great stuff) or set up a consultation with your physical therapist. With summer drawing to a close, we’ll have more than enough frozen things headed our way – make sure your shoulder isn’t one of them!