Frozen shoulder is the name given to a stiff and painful shoulder joint which follows a typical pattern. It is also known as capsulitis or traumatic arthritis. The patient is usually aged 45 or over and a frozen shoulder most often occurs on the non-dominant side i.e. the left handed patient will have a right frozen shoulder and visa versa. A frozen shoulder may follow minor injury such as a fall or even banging into a doorframe or slamming a car door awkwardly. The pain only comes on a week or so after the incident when the pain can radiate down the arm to the wrist. The pain gradually increases at first then recedes up the arm into the shoulder joint over the next 4 months. The patient almost always describes the pain as being in the muscle of the shoulder, that is the bulk of the shoulder that gives it its shape. After about a month the arm is painful even at rest and the patient has difficulty lying on the bad side at night. The joint becomes progressively stiffer and more painful at first then the pain eases and the shoulder remains very stiff. Left untreated the shoulder will not regain full range of movement inside 12 to 18 months.
Pain and stiffness mean a curtailment of normal activities. Taking the hand behind the back to do up a bra or a zip is difficult and the patient often finds combing their hair painful. Tucking a shirt in or reaching into a back pocket is also usually difficult and painful. The unusual thing about frozen shoulder is that the capsular pattern of limitation of movement is the same in every patient. So all patients still have some movement out to the side or up in front but are almost unable to get their hand behind their back or up behind their head.
The shoulder like most joints in the body has two surfaces of bone that are lined with cartilage. These surfaces are kept lubricated with fluid which is held around the joint in a capsule. This capsule is rather like a thick plastic bag which attaches to the edges of the bony surfaces and is lax enough to allow movement. In a frozen shoulder the capsule itself becomes inflamed and swollen restricting the movement at the shoulder joint. It is never a good idea to push a joint into pain. If you continue to aggravate the capsule whilst it is swollen and inflamed then the movement will only serve to increase the swelling, increase the pain and reduce the range of movement still further.
A GOOD RULE OF THUMB IS ‘IF IT HURTS DON’T DO IT.’ Unfortunately because the onset of frozen shoulder is gradual most people take almost 3 months to realise that the pain in their shoulder isn’t getting any better! If a patient has pain in the shoulder joint lasting for more than a few days it is important to seek professional advice rather than waiting to see ‘if it goes away’. The sooner treatment is commenced the less likely the inflammation is to take hold.
Treatment with Manual Lymph Drainage and Connective Tissue Manipulation aims to release the tension in the connective tissue around the shoulder which improves the circulation and reduces the inflammation in the capsule allowing the body to accelerate the healing process. The pain is reduced and the stiffness improves. The patient is therefore able to regain full movement and return to normal activities.