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Frozen Shoulder

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Those of you that have experienced frozen shoulder, also known as adhesive capsulitis of the shoulder, will know that it can be painful and persistently stiff for months, sometimes years.

This means it can be difficult to carry out certain tasks such as dressing, driving, and sleeping comfortably. Symptoms do tend to resolve over time, but perhaps it’s worth coming to see one of our osteopaths who can help ease some of the pain and stiffness.

It is estimated that 1 in 20 people in the UK have suffered from frozen shoulder at some stage in their lives. The majority of patients are between the ages of 40-60, and it is more common in women than men.

What is frozen shoulder?

It occurs when bands of scar tissue form inside the capsule that surrounds the shoulder joint. This causes tissue inflammation and thickening, making the tissue tighter, causing pain. Due to the swelling, there is less space in the joint for the upper arm bone (humerus), meaning movement is restricted.

Stages of the condition:

1) ‘Freezing’ stage – the shoulder starts to ache, and becomes very painful when reaching out for things. The pain is worse at night, and when you lie on the affected side. The pain can last between 2-9 months.

2) ‘Frozen’ stage – the shoulder becomes increasingly stiff; but the pain doesn’t get worse and may even decrease. Shoulder muscles may waste away slightly as they aren’t being used. This usually lasts 4-12 months.

3) ‘Thawing’ phase – you may regain some movement in your shoulder. The pain begins to fade, although it may come back occasionally. You may or may not regain full movement of your shoulder, but more tasks can be carried out. This stage normally lasts between 6-12 months.

It is not fully understood why frozen shoulder occurs, however, the following conditions are thought to increase the risk of developing the condition:

Diabetes

A recent study which compared the prevalence of frozen shoulder in diabetes type 1 and diabetes-free subjects, showed that frozen shoulder was diagnosed in 59% of patients with diabetes compared with 0 in the diabetes-free group (Juel NG et al, 2017).

It is estimated that people with diabetes are twice as likely to suffer from frozen shoulder, and that the symptoms will be more severe and harder to treat. They are also more likely to develop the condition in both shoulders (www.nhs.uk).

Dupuytren’s contracture

Dupuytrens’s contracture is a condition that causes one or more fingers to bend into the palm of the hand. It occurs when the connective tissue in the palm thickens, often causing a nodule (a hard lump) under the skin. These nodules then extend, and can shorten, causing the finger to bend towards the palm.

The British Dupuytren’s Society states that ‘Dupuytren’s patients have an 8 times higher chance of getting a frozen shoulder, and 18-50% of frozen shoulder patients have or develop Dupuytren’s disease as well’.

Heart disease and stroke have also been linked with frozen shoulder, but as with the two conditions mentioned, the reason behind this is not fully understood.

Treatment:

Your osteopath may ask you:

  • When your symptoms started? Was it after a particular incident?
  • What is the severity of the pain?
  • Do you have any other symptoms with it?
  • How is it affecting your daily life?
  • Is the pain affecting your sleep?
  • Is there anything that makes the pain better or worse?
  • Do you have any other health conditions?

Treatment with shoulder exercises and painkillers can help reduce pain and improve movement until it heals.

Regular, gentle stretching exercises can help to keep the joint mobile.

You could also try massage and acupuncture to help improve the symptoms. As with other injuries and conditions, thermotherapy with hot and cold packs may be of benefit.

References:

  • Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of >=45 Years’ Duration: The Dialong Shoulder Study. Juel N.G., Brox J.I., Brunborg C., Holte K.B., Berg T.J.  Archives of Physical Medicine and Rehabilitation. 98 (8) (pp 1551-1559), 2017. Date of Publication: August 2017. Publisher W.B. Saunders
  • http://dupuytrens-society.org.uk
  • http://www.nhs.uk/Conditions/Frozen-shoulder/Pages/Introduction.aspx
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