What is Frozen Shoulder? (Adhesive Capsulitis)
Frozen Shoulder Syndrome (FSS) is a common and debilitating condition. It is a clinical diagnosis and is only very rarely the result of an underlying illness or pathology. FSS is common, affecting 2-5% of the population. One of the many enigmas is that, once cured it (almost) never comes back again.
The condition is often misdiagnosed so we like to keep things simple and define it as a “a stiff shoulder with less than 50% of normal range of active and passive motion in any direction”.
The important point here is that you can’t lift the shoulder and neither can anyone else lift it for you – it is completely stiff and locked. Other conditions can cause the shoulder to stiffen but, typically, only in certain directions of movement.
I know what you are going through; the pain, the sleepless nights, the stiffness, the inability to do even the simplest tasks. Worst of all, you look normal to the world outside and yet you are suffering within. The good news is that it will get better and there are things you can do to speed it up.
In a Frozen Shoulder Syndrome the lax capsular sack becomes sticky and can sometimes (though not always) form adhesions; hence the name of the condition. The stickiness is brought on through inflammation; research has pinpointed the source of this is in the rotator interval. This inflammation often starts in the groove behind the biceps tendon. (This can occur after a small injury, like reaching for the back seat of the car but often you may not remember anything). Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae). This is because the muscles, ligaments and bursae within the shoulder are very much interconnected.
The stiffness is due to an ‘over-reaction’ of the body to the inflammation (within the rotator interval/biceps groove). The body then seems to ‘switch off’ muscles in a co-ordinated sequence; this sequence is the same for everyone and we call it the ‘capsular pattern’. In less than a week the arm movements start to diminish, and within a few weeks the arm literally becomes frozen and for many, can not be raised more than 40° in any direction. The muscles of the rotator cuff become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.
Causes of Frozen Shoulder
Despite the fact that Dr Duplay first described the syndrome in the late 19th Century, the causes of frozen shoulder (or Adhesive Capsulitis) are poorly understood.
It often appears for no apparent reason (primary) but can stem from an injury to the shoulder (secondary). In our experience it tends to start with a ‘tweak’ in the shoulder that doesn’t seem to resolve. Often after reaching behind – for example on to the back seat of the car! This ‘tweak’ seems to occur in the region of the long head of the biceps; it is the cause of that horrible sharp catching pain.
Frozen Shoulder can last up to 30 months if left untreated, but there is a proven technique that can relieve the symptoms and speed up recovery. The trestment therapy I use is the Niel-Asher Technique™ (NAT) Once cured, Frozen Shoulder almost never re-occurs (in the same shoulder).
Risk Factors for Frozen Shoulder
- Aging – In Japan frozen shoulder syndrome is called “Fifties Shoulder”.
- Posture – especially round-shouldered
- Shoulder-intensive sports
- Shoulder intensive or repetitive manual occupation
- Diabetes – Types I and II
- Immobilization / splinting
- Fracture of the collar bone or humerus (arm bone)
- Surgery (especially after shoulder surgery, or mastectomy with breast reconstruction)
How Long does Frozen Shoulder Last?
We generally observe four distinct phases which – without treatment -endure over an average period of 30 months.
|Without Treatment||Niel-Asher Technique™|
|Pre-Freezing (0-4 weeks)||1-5 Sessions|
|Freezing (1-8 months)||7-13 Sessions|
|Frozen (9-16 months)||5-8 Sessions|
|Thawing (12-40 months)||4-7 Sessions|
*This is an average and may vary if there is another underlying shoulder pathology like a rotator cuff tendon problem or if there is diabetes (which usually slows the healing process by 50%).
Frozen Shoulder Fact File
Why Frozen Shoulder May Develop?
Hormonal – In the case of female patients, Frozen Shoulder occurs more commonly at about the same time as the menopause.
Genetic – Several studies have indicated that there is a genetic component for developing a Frozen Shoulder. For example, there have been cases where identical twins have suffered at the exact same time. It is also a condition that can run in the family.
Autoimmune – There is a theory that the body mounts a rejection type reaction to damaged shoulder tendons, perceiving them to be foreign material. This may also explain why Frozen Shoulder does not return on the same side.
Postural – The most convincing study results yet have indicated that long-standing round-shouldered posture causes a shortening in one of the shoulder ligaments. This chronic ligamentous shortening seems to be very closely associated with the Frozen Shoulder.