Frozen shoulder or adhesive capsulitis is a thickening of the capsule around the shoulder joint that results in a loss of range of motion. The thickening can be a result of an injury to the shoulder, or immobilization such as holding the arm in a sling for a long period of time. Many times, the shoulder will “freeze” without any prior significant injury or immobility. The “freezing” process and onset of the condition itself is not well understood by medical professionals and sports medicine physicians.
What is known, is that to undo the “freezing” the patient is in for an uncomfortable period of forced mobilization by a trained practitioner. In extreme cases, with the patient under anesthetic, a medical professional will force the arm's range of motion to tear the thick adhesions of the shoulder capsule. There are many reported instances of the adhesions being so strong that the humerus bone will actually break from the forced movement before the adhesions release. Again, this is in extreme cases. In eleven-plus years of practice, and having seen countless cases of frozen shoulder, I have only known one patient to have had such a break, and that was one of only two that even required anesthetic.
More commonly the shoulder will be evaluated to determine where the range of motion is lacking, and therefore what portion of the capsule is frozen. At this point, during treatments that can last several weeks, gradual increases will be made by forcing the shoulder into the areas of decreased range. A skilled practitioner will be mindful of the keeping the shoulder in the correct positional orientation so that further complications do not arise as a result of just yanking on the arm.
In addition, the patient will be given exercises to perform at home to continue to gain range of motion, as well as to not lose what has been gained at each visit. These are often done in front of a mirror to self-monitor how the shoulder is moving, and to ensure that compensatory muscles are not doing too much in the role of moving the arm. For example, it is very common that when raising an arm on the side of an injured shoulder that the upper trapezius muscle will do more than its fair share of work in lifting the shoulder up closer to the ear to account for the motion that is not occurring at the shoulder joint. This does nothing for improving shoulder mobility, and can create aberrant neuromuscular patterns which will create problems that will last after the shoulder has healed.
If you have frozen shoulder, or have noticed that your range of motion is not what it should be, please contact your local joint specialist and/or sports medicine provider. While the treatment is rarely comfortable, it is far preferable to not having full use of one of your arms.
If you have further questions about this post, or about frozen shoulder in general, please do not hesitate to contact Dr. Stoughton via email at firstname.lastname@example.org or through Evergreen Spine & Sport Medicine at 303-670-8902.