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Shoulder Pain | Adhesive Capsulitis | Frozen Shoulder

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Adhesive capsulitis, or frozen shoulder, is a condition where the shoulder capsule becomes thick, stiff, and inflamed, causing stiffness, reduced range of motion, and pain in the shoulder and sometimes the upper arm. The shoulder capsule is connective tissue which covers the joint where the upper arm bone (humerus) fits into the socket of the shoulder blade (scapula).

Signs and symptoms usually appear gradually, get worse over time, and then gradually go away. The entire process from the onset of symptoms until the symptoms go away can take 2-3 years.

The vast majority of people improve with a treatment plan of non-steroidal anti-inflammatory medicines, steroid injections, and physical therapy which involves stretching and range-of-motion exercises. If this type of treatment is not successful, surgical treatments like manipulation under anesthesia and shoulder arthroscopy are available.

The causes of frozen shoulder are not clear.

Source:

Mayo Clinic Staff. (April 28, 2011). "Frozen shoulder". Mayo Clinic. Retrieved 2014-10-27.

(January, 2011). "Frozen shoulder". OrthoInfo | American Academy of Orthopaedic Surgeons. Retrieved 2014-10-27.

Commentary:

I was recently diagnosed with frozen shoulder. The discomfort started about a year ago. The first time I noticed any pain was while shooting a basketball after a long, two-hour workout. I assumed I had just strained or slightly pulled a muscle in my upper arm or shoulder, so I backed off any shoulder work at the gym and stopped swimming for a while. When I resumed those activities there was less discomfort, but I still felt a tightness in my upper arm running between my biceps and triceps.

For the next several months I paid close attention to how my injury was feeling. Sometimes I would push myself, thinking more exercise of that area might help it improve, and other times I would just lay off. I also starting applying ice to my upper arm at night, which seemed to help relieve some of the discomfort.

But over time, my injury got progressively worse. Sudden reaches to the side or behind me, reaching up to get a glass from the cupboard, or sleeping on my affected shoulder caused a lot of pain, and my range of motion had decreased significantly. At this point I would have gone to see a doctor, but with no health insurance that wasn't an option.

Then, about a year after the onset of symptoms (and now fully-insured), I was able to have my shoulder looked at and evaluated by an orthopedic MD. The x-rays and MRI showed no muscle tears, and I was diagnosed with frozen shoulder. The treatment was an initial shot of cortisone, followed by 15 sessions of physical therapy.

The physical therapy consisted of massage and lots of stretching by my therapist, along with a host of exercises which I would do at the therapist's location and at home on my own. The stretches performed by my therapist were basically arm motions up above my head, external rotation of my arm, and internal rotation of my arm. And yes, there was a fair amount of discomfort while I was being stretched.

I'm happy to say that over six weeks this regimen has made a huge difference. My range of motion above my head is nearly 100%, and my rotation is much improved.

What follow is a list of the exercises I did as part of my treatment.

Stretches and Exercises for Frozen Shoulder:

  • Pulleys (arms out in front of your body, arms externally-rotated at a 45-degree angle, arms externally-rotated at a 90-degree angle), extending the arms alternately upward as far as possible and holding briefly at the top, three minutes each orientation
  • Shoulder Slides (arm extended, arm stationary), sitting next to a table, leaning forward and extending the arm as far as possible (reaching with the fingertips), then keeping the arm stationary while leaning forward as far as possible, one set of 10-15 reps each arm position
  • Scapula Retractions (seated and face down), focusing on and contracting the muscles in the mid-back, holding the position for 3-5 seconds, two sets of 10-15 reps
  • Wall Walks (facing a wall, at 90-degrees to a wall), standing up close and facing a wall, slowly crawling your fingers up the wall overhead as far as possible, holding briefly at the top, repeat 10 times, then repeat the exercise with your side to a wall (abduction)
  • External Rotation (lying on your side with the affected shoulder up, two different arm positions, doorway stretches)
  • Internal Rotation ("Sleeper" stretch, on your side with affected shoulder down, elbow fixed, using opposite hand to create the stretch, 3 reps with 20-second holds)
  • Three-pack (face down, arms swing up at your side with palms down, arms swing up at 90-degrees to your body with palms down (abduction), arms swing up at 90-degrees with thumbs up, 10 reps with 5-second holds)
  • Foam Roller (reach to sky, reach with shoulder rolls forward and backward, arms parallel to body with top to bottom motion, arms at 90-degrees)

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