Frozen shoulder, or adhesive capsulitis as is it called in the medical community, is a relatively common condition that we really should know more about. The more we know, the greater chance we have of avoiding it altogether. Oh, and just so you know, it can actually be exacerbated by cold temperatures.
Adhesive Capsulitis is characterized by non-specific pain in the shoulder and varying degrees of restricted mobility in the glenohumeral (GH) joint. To clarify this further, it’s not necessarily the whole shoulder involved, which includes movements of the scapula. The worse it gets, the less movement you have.
How does movement get restricted?
The mechanisms involved in creating the restriction in the GH joint happens are still somewhat of a mystery. We do know that the volume of synovial fluid in the joint goes from about 30mL in a healthy GH joint to about 10mL in frozen shoulder (reference). Synovial fluid is crucial to ensuring smooth movement at the joint.
In addition to reduced lubrication and joint volume, contracture and fibrosis of the connective tissue that forms the joint capsule occurs. The joint capsule and the synovial membrane thicken (with scar tissue), which restricts the joint further and can lead to inflammation and more pain. The soft-tissue structures that comprise the joint cpasule include the tendons of teres minor, infraspinatus, subscapularis, supraspinatus the biceps long head. (Reference).
Typically, the most restricted movement is lateral (external) rotation of the humerus, however frozen shoulder also usually involves a significantly reduced range of motion in all planes and with all other movements.
How does this happen?
You are more likely to get Frozen shoulder in a variety of different scenarios, including (but not limited to) injury, lack of movement in daily activities, diabetes mellitus, upper crossed syndrome (and associated kyphosis), changes in weather and psychological stress. But like I mentioned above, there’s no fixed or set formula (at least that we know of yet) that causes Adhesive capsulitis.
Can it be treated?
Yes and no.
Because we don’t have clearly defined pathways of pathophysiology, it’s difficult to qualify and standardize effective therapeutic treatment options. Many different methods of management have been identified (including massage) that show some degree of therapeutic value.
The combination of massage, acupuncture and a home-exercise program has shown to be a consistently more effective treatment regimen than individual treatments.
We’ve seen and been a part of the resolution of frozen shoulder through the application of massage. This is of course, anecdotal evidence and personal experience, however it’s promising and gives cause for greater investigation of the role of massage in the management of adhesive capsulitis.
As a therapist, the first thing that needs to happen is identifying which structures are primarily involved through a thorough movement assessment.
What happens if massage doesn’t work?
My suggestion would be to try out another therapist who has previous experience, and good results working with adhesive capsulitis.
But if that also does not work, frozen shoulder typically does resolve itself spontaneously within an average of 26 months. It can become chronic and last beyond this time frame, but this only occurs in about 10-15% of cases. Alternate and more drastic interventions exist in the case of a chronically frozen shoulder.