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Home Health Left untreated, frozen shoulder can become disabling
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Left untreated, frozen shoulder can become disabling
Written by Ken Chisholm RN; BS; CNOR; CRNFA; OPA   
Monday, 08 March 2010 09:43

No, this is not a description of a Friday-night Happy Hour special with an umbrella in it. It is actually a description of a condition that is affecting more and more people.

Does your shoulder ache? Ladies, is it getting more difficult to do your hair? Guys, are you having an unusually hard time reaching back for that wallet of yours? Is that second or third shelf in the cupboards no longer reachable?

Well, it could be a case of “frozen shoulder.” No, not frozen daiquiri…shoulder!

The technical term for frozen shoulder syndrome is adhesive capsulitis, and this condition can become quite disabling if left untreated for too long.

Adhesive Capsulitis, uh, frozen shoulder, is a condition characterized by the slow, insidious onset of stiffness in the shoulder, typically as a result of a buildup of bands of scar tissue called adhesions. The key thing to understand here is the slow, almost imperceptible, progression of the stiffness, until it becomes noticeable, which is, unfortunately, when the mobility of the shoulder has decreased significantly.

So, what causes frozen shoulder anyway?

Many factors can be responsible for the development of adhesive capsulitis. More often than not, some initial incident is responsible for causing either minor injury of or irritation to, the soft tissues within the shoulder girdle, such as the joint capsule, bursa sac or even the rotator cuff tendon complex.

Strains and sprains are frequently all that is needed to spark an inflammatory response in the tissues. This inflammation begins very subtly and progress slowly. Most of the time, one doesn’t even know there is any form of lasting irritation, and thus, no real attention is paid to it.

Another cause can be from any trauma received by the shoulder, even something you wouldn’t consider to be severe enough. Bumping the shoulder, lifting a heavy object and repetitive overuse are a few examples. These activities, in themselves, would not be cause for any real attention, so the initial inflammation is left un-diagnosed, un-appreciated and therefore un-resolved.

Yet another potential cause for frozen shoulder syndrome to develop is actually another condition in itself – impingement syndrome. Shoulder impingement syndrome is frequently characterized by shoulder bursitis, biceps tendinitis, rotator cuff tendonitis and even bone spur formation on the undersurface of the acromion, or roof of the shoulder.

In cases of impingement, the bone spur that literally “hangs down” on the front edge of the acromion begins to cause a rubbing friction against the bursa and occasionally, the rotator cuff tissue.

What follows is usually the onset of inflammation of the joint capsule and synovial lining, otherwise known as synovitis. As this inflammation and irritation progresses and becomes chronic in nature, bands of scar tissue begin to develop. Since these bands have little-to-no elastic properties to them, they begin to act as “straps”, causing more and more mobility restrictions, to the point where ordinary daily activities can be impossible to perform. The longer the inflammation brews, the more restrictive the shoulder becomes.

So how does one get rid of this?

If diagnosed in the early stages, treatment consisting of pain medication, anti-inflammatory drugs and physical therapy can usually ward off the symptoms, allowing for the return of satisfactory arm and shoulder mobility.

As the condition becomes more severe, cortisone injections with more aggressive forms of therapy may be required. By now, it’s usually pretty difficult to move the arm to the extent needed without considerable pain and soreness. Which brings us to the next level of treatment; shoulder manipulation.

Manipulation of the shoulder is typically performed under a short-acting general anesthetic, so the patient feels nothing and maximum “technique” can be exerted upon the shoulder. As these bands are broken up, it can actually sound and feel like popcorn popping or chicken legs being disjointed from the thighs.

Once this has been successfully accomplished physical therapy, usually daily for the first 10 to 14 days, is implemented. It is important to keep the shoulder and arm moving especially after manipulation, mainly to prevent or minimize the potential for recurrence of the scar bands from inflammation caused by the manipulation.

In some cases, shoulder arthroscopy directly after manipulation to release more scar and clean out inflamed bursa tissue has been found to be quite successful. Like the manipulation alone, aggressive physical therapy and anti-inflammatory drugs should be available.

So, if hair time is getting difficult, and hubby can’t get to his wallet and credit cards, or someone is starving because getting the plates out of the cupboards to eat dinner is no longer feasible, this may well be a case of adhesive capsulitis, or frozen shoulder. You need to get this looked at by your physician or other health care provider before the stiffness becomes incapacitating.

Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care. For additional information on orthopedic-related topics, visit Ken’s Web site at www.bone-and-joint-pain.com. Submit questions or comments to Ken at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or at his Web site.

 
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