Frozen shoulder is the common name given to adhesive shoulder capsulitis. Frozen shoulder or adhesive capsulitis describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint (joint between the humerus and the scapula - see diagram), leading to stiffness, pain and dysfunction.
The term “frozen shoulder” was used in 1934 by Dr Ernest Amory Codman to describe the debilitating loss of shoulder mobility in patients affected by the condition.
Adhesive capsulitis is a fairly rare condition and the incidence of adhesive capsulitis in the general population is approximately 3% to 5% but can be higher for people with underlying conditions - it can be as high as 20% in patients with diabetes for example.
What causes adhesive capsulitis?
Adhesive capsulitis can be primary or secondary. Primary (no known cause) adhesive capsulitis can occur spontaneously without any specific trauma or incident. Secondary adhesive capsulitis is often observed after severe trauma of the glenohumeral joint or other severe articular trauma around the shoulder joint. It can also be a severe complication after open or arthroscopic shoulder surgery, including rotator cuff repair and shoulder arthroplasty. (1)
Signs and Symptoms of adhesive capsulitis
Clinically, patients will typically present with shoulder pain initially followed by gradual loss of motion of the shoulder joint. The interesting fact is that the vast majority of patients (90%) will present with shoulder pain before losing mobility in the shoulder joint. External rotation (moving the shoulder outward) is often the motion that is affected first with a global loss of the other ranges of movement as the condition progresses. Frozen shoulder progression can be divided into 3 phases.
Phase 1 is the painful phase where patients present with shoulder pain - especially at night - without any loss of mobility in the joint.
Phase 2 is the restriction phase where patients start to develop stiffness in the joint which would lead to some more severe shoulder joint restriction. In phase 2, movement is restricted and pain is usually only at the end of range of movement.
Phase 3 is the recovery phase where there is persistent stiffness in the shoulder joint but with minimal pain. Patients may start to recover some mobility in the shoulder joint at this stage.
The duration of each phase can vary from patient to patient. Studies have shown that each phase can last between 1 and 12 months making adhesive capsulitis a condition that can affect the patients over a long period of time (3 to 36months).
Diagnosis
The diagnosis of adhesive capsulitis is a clinical diagnosis usually made based on the medical history and physical examination. It is often a diagnosis of exclusion, meaning other causes of painful, stiff shoulder are excluded before making a diagnosis of frozen shoulder. As mentioned above, true frozen shoulders are rare and can be easily misdiagnosed, especially in the early stage of the painful phase. Therefore, the condition is often diagnosed when it is in phase 2 where stiffness and loss of range of motion are present.
How can osteopathy help?
As mentioned above, other potential causes for shoulder pain must be excluded before making the diagnosis of frozen shoulder. Therefore a thorough case history taking and physical examination are essential. Once the diagnosis of frozen shoulder is established, soft tissue mobilization around the shoulder joint and shoulder joint mobilization itself can be useful to help maintain some mobility in the shoulder joint. Specific exercises such as self-mobilization and stretching can also be beneficial.
In all cases, the treatment and self-management approach should be tailored to the patient’s specific needs depending on the phase they are in and the progression of the condition.
1. Bailie DS, Linas PJ, Ellenbecker TS. Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age. J Bone Joint Surg Am 2008; 90: 110–117. [PubMed] [Google Scholar]