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Article Archive >> Good Health

The therapist is in... Stuck shoulders

The therapist is in...
Stuck shoulders
by Shannon Murphy, MPT

During the dead of winter, it might feel as though all of your joints are frozen! But a truly "frozen shoulder" can lock up during any season. The condition is called adhesive capsulitis, and develops when the capsule around the shoulder joint becomes inflamed and thickened. The tissue essentially becomes "too small" for the ball and socket, creating a trademark stiffness in the joint.
What causes frozen shoulder? And who gets it?
Although trauma can play a role, many people develop the condition without any known injury at all. The most susceptible populations include:
* Middle-aged women. The syndrome typically affects patients between 40-60 years of age and is twice as likely to occur in women than men.
* People with endocrine and systemic disorders (e.g., diabetes, hypothyroidism, heart disease) develop problems more frequently than others, although the exact reasons are unclear (widespread inflammation is one theory)
* People with a history of recent surgery - patients who undergo shoulder, chest, or breast surgery are at high risk. This is especially true for patients whose recovery process includes long periods in a sling.
What are the symptoms?
* Dull, aching shoulder pain
* The inability to move the arm shoulder normally (especially overhead or behind the back)
* Difficulty with everyday tasks like getting dressed or reaching dishes
* Pain with sleeping on the affected side
What can be done?
A mixture of stretching, medications (like anti-inflammatories) and patience is required. "Classic" adhesive capsulitis tends to progress through three phases, which can take more than a year to complete. Surgery or manipulation-under-anesthesia tends to be a last resort.
Stage 1: Usually lasts between 6-12 weeks and is the most painful, but most brief, stage. Motion tends to be a little stiff in the shoulder, but not extreme. People tend to dismiss symptoms at this stage, particularly if problems are in the non-dominant arm.
Stage 2: Tends to last longer than the initial phase, and significant stiffness sets into the shoulder. Functional limitations become more apparent, and secondary problems in the neck and back can develop from compensatory movements and altered mechanics.
Stage 3: Eventually, most people 'turn a corner' and range of motion starts to improve. While the thawing stage brings relief, it can take many months of recovery to regain normal function.
There is debate about whether early intervention like injections or therapy can affect the time span of adhesive capsulitis. While the ultimate behavior of the syndrome may depend on the factors driving it (e.g. a post-surgical shoulder may respond more quickly than one related to under managed systemic diseases), the ability to affect pain and mobility is a critical component at every stage. It is better to keep things gently moving and limit development of secondary problems than to simply "wait it out".
It is also important to realize that not all stiffness is true 'adhesive capsulitis'. Many other problems, including rotator cuff tears, impingement, arthritis and muscular tightness can create movement problems in the arm. Many of these problems respond more quickly to treatment, although the amount of improvement depends on the extent of injury.
If you are noticing problems with using your arm, don't just shrug it off! Talk to your doctor and don't let the 'deep freeze' sneak up on you.

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax, smurphy@bodysensept.com.

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