Ask the Therapist?
Featured in the Town Observer Newspaper
by Carol Pietromonaco PT. -
Physical Therapy Plus
Q. I have been having pain at night, particularly when I lie on my right shoulder. It also hurts when I perform activities such as reaching into my back pocket, putting on my coat, and brushing my hair. It seems as though my shoulder has become stiff, or frozen, for no reason. Can you give me any advice?
A. Your history indicates that you may have what medical professionals call “adhesive capsulitis” of the glenohumeral or shoulder joint. It is often described to patients as “frozen shoulder syndrome” The problem is manifested as stiffness in the shoulder joint with most activities of daily living. It is often accompanied by pain particularly in the early phases.
The actual cause of frozen shoulder is at still not known. It is often found after periods of prolonged illness or bed rest. It is known that certain conditions, such as diabetes, can put patients at greater risk. Here is a list of what we do know about frozen shoulders:
• The frozen shoulder usually occurs between the ages of 40-60 and is seen 60-70 % more frequently in women. There is little to no research to show that a frozen joint occurs anywhere else in the body except the shoulder joint.
• It is rare for a frozen shoulder to have an underlying pathology. X-Rays and MRI of the frozen shoulder are often normal without any evidence of fractures or bone disease. There are occasional findings of bursitis and or rotator cuff tendonitis.
• Frozen shoulder syndrome affects between 2 to 5% of the population and is more common in the non-dominant shoulder. There is evidence of a possible genetic or familial factor with people having increased incidence of frozen shoulders when there are other members in their family that have had this condition.
Researchers have shown that the onset of a frozen shoulder can last as long as 20-30 months and is usually accompanied by three stages during the course of recovery.
STAGE I: lasting between a few weeks to 8-9 months
This is described as the freezing phase with gradual loss of shoulder motion. During this stage, the patient develops a slow onset of pain that becomes worse with time. Patients often complain that they experience extreme pain even before they reach the end range of their shoulder movement.
STAGE II:
This is described as the frozen phase where there is some improvement in the shoulder pain, but the stiffness remains. This stage lasts from 4 to l2 months.
STAGE III:
This final stage is described as the thawing phase. During this phase, the shoulder gradually returns to normal motion. It can last anywhere from 6 months to 3 years.
It is important to see a physician to make sure that there is not some underlying pathology causing the frozen shoulder. Treatment of the frozen shoulder is very difficult during the initial freezing stage. Patients do not respond to aggressive physical therapy and often get only minimal relief from medication and steroid injections. During this stage patients do benefit from instructions in how to gently mobilize their shoulder at home to help minimize the adhesions and stiffness. The treatment of the frozen shoulder is much more affective during Stage II and Stage III, after the shoulder is no longer so painful to move. A well-designed physical therapy program can assist you in a faster recovery and can help identify some other postural faults and muscle imbalance that may be contributing to your shoulder problem.
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