The shoulder joint is a modified
ball and socket joint. The ball is at the top of the Humerus (arm bone), whilst
the socket is a shallow cup on the end of the scapula (shoulder blade). This is
a good design to give mobility to the shoulder joint but it makes it inherently
unstable, and dislocation is common. To improve the stability of the shoulder a
cuff of four muscles (called the rotator cuff) braces the joint as well as a
complex plethora of tough internal ligaments. Surrounding the Gleno-humeral
joint (shoulder joint) is a bag called the CAPSULE. When the arm is raised
above the head, this CAPSULE is fully stretched; when the arm is lowered to the
side, the capsule hangs down in a small pouch-like sack.
Frozen shoulder, or adhesive
capsulitis, is a condition that causes restriction of motion in the shoulder
joint. The cause of a frozen shoulder is not well understood, but it often
occurs for no known reason. Frozen shoulder causes the capsule surrounding the
shoulder joint to contract and form scar tissue.
What causes frozen shoulder?
Most often, frozen shoulder occurs with no associated injury or discernible
cause. There are patients who develop a frozen shoulder after a traumatic
injury to the shoulder, but this is not the usual cause. Some risk factors for
developing a frozen shoulder include:
- Age & Gender
Frozen shoulder most commonly affects patients between the ages of 40 to
60 years old, and it is twice as common in women than in men.
- Endocrine Disorders
Patients with diabetes are at particular risk for developing a frozen
shoulder. Other endocrine abnormalities, such as thyroid problems, can
also lead to this condition.
- Shoulder Trauma or Surgery
Patients who sustain a shoulder injury, or undergo surgery on the shoulder
can develop a frozen shoulder joint. When injury or surgery is followed by
prolonged joint immobilization, the risk of developing a frozen shoulder
- Other Systemic Conditions
Several systemic conditions such as heart disease and Parkinson's disease
have also been associated with an increased risk for developing a frozen
What happens with a frozen shoulder?
No one really understands why some people develop a frozen shoulder. For some
reason, the shoulder joint becomes stiff and scarred. The shoulder joint is a
ball and socket joint. The ball is the top of the arm bone (the humeral head),
and the socket is part of the shoulder blade (the glenoid). Surrounding this
ball-and-socket joint is a capsule of tissue that envelops the joint.
Normally, the shoulder joint allows
more motion than any other joint in the body. When a patient develops a frozen
shoulder, the capsule that surrounds the shoulder joint becomes contracted. The
patients form bands of scar tissue called adhesions. The contraction of the
capsule and the formation of the adhesions cause the frozen shoulder to become
stiff and cause movement to become painful.
The pain of a Frozen Shoulder can be horrendous. Ask a sufferer what the
pain would be on a scale between 1 and 10 and you’ll often hear 20.
The major symptoms of Frozen Shoulder are:
pain and especially when trying to lay on the affected side.
sharp catching pain at the front of the shoulder when you inadvertently
extend the arm and lasting up to a minute or so. (You have to protectively
hold the shoulder tightly.)
reaching for the hip pocket, (not necessarily a bad thing if it’s your
shout), putting on or taking off a coat, brushing the hair and inability
to do up a bra.
- Pain down
the outer upper side of the arm.
of tendons causes severe limitation in movement, especially reaching up
behind the back.
Immobility / Stiffness
This is the key diagnosis of a Frozen Shoulder. You can’t move the arm and
neither can anyone else if they attempt to lift the arm for you. If they do
try, it’s very painful and you want to kill them for their effort.
From when you first notice the pain, the shoulder becomes stiff or stuck for
a period that could be between 48 hours to a month and it’s all downhill from
there. If your shoulder is not ‘stuck’ you may not have a true Frozen Shoulder.
Many people are forced to give up work as a result of the pain and stiffness
that commonly persist for many years.
The inability to work and the constant pain and stiffness can have a
considerable impact on you psychologically as well as financially, and you can
become extremely depressed and anxious as a result.
Frozen Shoulder Facts:
- 2-5% of
the population suffer from it. This doesn’t mean 98-95% enjoy it.
- It is more
common in women (60%)
- It is
five times more common in diabetics
- It is
common, but not limited to people with Dupuytren’s contracture (an
uncommon hand condition where the connective tissue under the skin of the
palm contracts and hardens over time.
- It may be
genetic. i.e it can run in the family.
- It seems
to affect 40-70 year olds.
- About 15%
of people get it on both sides.
There are three phases to Frozen Shoulder, (which lasts an average of 30
months. Some say longer).
1. Freezing (1 – 8 months) You notice some things you normally do are
starting to hurt.
2. Frozen (9 – 16 months) It’s full on! Any movement using the arm is
3. Thawing (12 – 24 months) Slowly gets back to normal and pain free use of the
Not much to look forward to, is it.
The pain and loss of function associated with this condition can become so
severe that it can significantly affect the quality of life, and prevent some
people from sleeping well or working.
What causes a Frozen Shoulder?
There’s no explanation for the development of Frozen Shoulder in most
patients. The majority of cases seem to be more prevalent in women. Some who
develop Frozen Shoulder have sustained an injury and developed stiffness as a
result. The trauma can be quite mild or severe, and the body’s response to the
event is probably more important than the event itself.
What is happens inside a Frozen Shoulder?
The shoulder joint is a ball and socket joint. The ball is
at the top of the Humerus (arm bone), and the socket is a shallow cup on the
end of the Scapula (shoulder blade).
Surrounding the shoulder joint is a bag called the
Capsule. When the arm is raised above the head, this Capsule is fully
stretched. When the arm is lowered to the side, the capsule hangs down like a
To improve the stability of the shoulder a group of four muscles called the
Rotator Cuff braces the joint as well as an elaborate bunch internal ligaments.
In a Frozen Shoulder Syndrome the Lax Capsular Sack and the Synovial Fluid it
contains becomes sticky and thick and can sometimes form adhesion's. The
stickiness is brought on through inflammation. This can occur after a small
injury, but often you may not remember anything about it. Once established,
this inflammation spreads into other shoulder soft-tissues and can cause
swelling in other shoulder sacks (bursae).
The stiffness is an ‘overreaction’, or the shoulders attempt to counteract the
inflammation within the Biceps groove. The body seems to ‘switch off’ muscles
in a coordinated sequence. This sequence is the same for everyone. Arm
movements start to diminish, and within a few weeks the arm literally becomes
frozen and for many, cannot be raised more than 40° in any direction. The
muscles of the Rotator Cuff become weak and start slowly to waste away, leaving
the arm to hang stiff and immobile.
The shoulder may not be completely stiff for several months and both active
and passive movements are stiff and neither you nor anyone else can lift it
because it’s too painful!
Traditional treatments may include:
Cortisone injections are often tried during both the freezing and frozen phases.
It is usual to have up to four injections. Cortisone injections may give brief
periods of pain relief, but mostly, they seem to give only a few days or weeks
of symbolic respite. Cortisone, which is a steroid, is a crystalline substance
and is injected into the joint capsule.
Suprascapular Nerve Block:
The suprascapular nerve is the major sensory supply to the shoulder joint and
motor supply to the Supraspinatus and infraspinatus muscles.
A Suprascapular Nerve Block has been used in patients with severe pain
associated with Frozen Shoulder syndrome. This injection technique is usually
performed 3 times over as many weeks. It has given some relief for pain, but
has no effect on the stiffness in the shoulder. This injection consists of a
local anesthetic and steroid, and is done with x-ray guidance and involves
inserting a needle through skin and deeper tissues.
The procedure is not without pain. However, the skin and deeper tissues are
numbed with a local anesthetic. Most of the patients also receive intravenous
sedation which makes the procedure easier to tolerate.
Under anesthetic, manipulation can be performed in the freezing phase (after
about 6 months). It is performed under general anesthetic and followed up by
several months of physiotherapy. Complications arising from this include
fractures and dislocations of the Humerus, Rotator Cuff tears, increased
inflammation and scarring. Nerve damage can also occur, especially to the
Physiotherapy is commonly advised by doctors during the ‘Frozen’ stage
and is mainly aimed at keeping the shoulder mobile through stretching and
pushing the joint. However, it rarely seems to hasten the recovery of the
The good news is that even very severe types of Frozen Shoulder syndrome can be
treated effectively. Treating Frozen Shoulders is massage based and naturally utilizes the body’s own healing mechanisms. No drugs, no surgery. It utilizes a
specific sequence of manipulations to the shoulder joints and soft-tissues.
In a Frozen Shoulder there are masses of inflammation and on top of this the
brain starts to recruit the ‘wrong’ muscles to move the shoulder.
The body and the brain is tricked into healing itself by addressing the two
main components of the problem … pain and stiffness. Initially the aim is to
significantly reduce the pain by treating the swelling around various shoulder
tendons, especially the biceps tendon.
Following this, the technique moves on to rapidly ‘thaw’ and improve the
range of shoulder motion by stimulating a unique sequence of reflexes hidden
within the muscles. One reflex is triggered against another in sequence and the
arm is not forced. Instead it’s kept still whilst applying the pressure.
Patients treated in this massage based technique will notice a definite
improvement with each treatment session. These should be twice a week for
twenty to thirty minutes a session and complete relief should be within twelve
There is a couple of testimonials regarding Frozen Shoulders you might care
to visit, and if you believe you might be displaying the symptoms of this
condition… call me to talk about it.
Frozen Shoulders CAN be fixed… but it won’t happen with medication.
Call for an appointment
Thank you for the information provided
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