By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Frozen shoulder, or adhesive capsulitis, is a condition of the shoulder that results from severely tightened shoulder ligaments or joint capsule. There are many underlying causes of frozen shoulder. When frozen shoulder is classified as a Type-1 frozen shoulder it means that there was no apparent reason for the onset of stiffness. A Type-2 frozen shoulder means there is a known cause for the stiffness. There are many different underlying or direct causes.
The most common cause of an anatomical frozen shoulder is osteoarthritis or degenerative joint disease. You do not need to be elderly to experience a frozen shoulder secondary to degenerative changes. Patients in their 30’s and 40’s may experience this type of frozen shoulder if they have a history of heavy weight lifting, especially bench pressing, multiple shoulder injuries, or excessive repetitive trauma to the shoulders. Patients in their 40’s and 50’s that have torn the cartilage (labrum) or experienced a torn rotator cuff may develop a “stiff” or frozen shoulder because they have difficulty moving the shoulder. If they ignore the pain and limited motion, a frozen shoulder can develop in a matter of weeks. Patients in their 60’s, 70’s, and older can develop a frozen shoulder secondary to advanced degenerative changes and chronic rotator cuff tears. In this population, once the humeral head (or “ball” portion of the ball and socket joint) degenerates to the point that it changes shape; it will essentially become a square peg in a round hole. Once this happens, the shoulder will not move well, and will more than likely need a total shoulder replacement.
Some patients that experience a tight shoulder capsule after surgery or an injury are in for a complex road of physical therapy. If the patient’s shoulder becomes stiff before the surgery it will make it that much more difficult to restore the range of motion post-operatively.
The other causes of frozen shoulder are referred to as metabolic causes: anything related to the metabolic systems in the body. Typically patients that have diabetes or thyroid disease are more likely to develop frozen shoulder than those that don’t have one of these conditions. The other area that is not discussed very often is a patient with celiac, irritable bowel syndrome and other digestive disorders, including dietary sensitivities to gluten, sugar, dairy/lactose, etc.
Patients with Type-1 and Type-2 diabetes are prone to frozen shoulder syndrome due to altered sugar metabolism. The result is sugar deposition into the capsule. Subsequently the capsule becomes inflamed and scarred, resulting in increased pain and stiffness. Patients with a diabetic frozen shoulder will need to treat the diabetes both medically and dietarily in order to have a chance at resolving the stiffness. Without medical and dietary control of blood sugar levels, it will limit the effectiveness of physical therapy. Patients that experience chronic inflammation because of digestive disorders and digestive sensitivities will also struggle with physical therapy. In many ways, the dietary changes and modifications are more difficult than going to physical therapy. Diet for most of us is a matter of habit, and breaking bad dietary habits can be very difficult; but in the case of frozen shoulder, it is a necessary component of the treatment.
Waiting too long before having the stiff shoulder assessed is the major reason for developing frozen shoulder syndrome. There are some simple things that you can do as a self-assessment. If you can no longer reach behind your back and put your fingers in the opposite hip pocket, cannot reach across your chest and touch the opposite shoulder or you cannot place your hand on your head without bending your neck downward then you may be developing a frozen shoulder and you should have your shoulder assessed by a medical professional with experience in the assessment and treatment of frozen shoulder syndrome.
Most patients with frozen shoulder syndrome end up being treated with a multi-modal approach. This means several different treatments are happening concurrently. It is not uncommon for a patient to be given non-steroidal anti-inflammatories and some type of steroid medication or a steroid injection. These treatments are all aimed at reducing the inflammation. Physical therapy is geared towards increasing the range of motion and regaining the strength. Manual therapy techniques, flexibility exercises, and modalities are usually combined to help reduce the pain and regain the range of motion.
It is imperative that the patient performs their home exercise program as instructed! The patient needs to be dedicated to their recovery. Without consistent physical therapy, dietary modifications, medical treatment, and a diligent home exercise program, it becomes very difficult to resolve frozen shoulder syndrome. If your shoulder pain does not resolve in 10-14 days with basic home care, see a medical provider of your choice!