Have you been suffering with shoulder stiffness?
Severe shoulder pain associated with lack of motion?
Has this pain been present for months/years?
If you’ve nodded your way through these questions, you could be suffering from a condition called Frozen shoulder. Since it’s such a complex diagnosis, I’m going to split this into a series of blogs. Today let’s focus on the beginning, how does it come about? And who is at risk?
What exactly is a frozen shoulder?
Frozen shoulder is categorised as a self-limiting condition with significant pain in the shoulder associated with feelings of “stiffness” when the patient tries to move.
The cell process that occurs is complex so I will try to make it easy to understand (it’ll still be hard). When our shoulder is going through an inflammatory process (such as an injury) in addition to being placed under stress (such as stretching or weight lifting), contractions within the shoulder capsule occur, leading to a reduction of movement. These contractures occur as cells called fibroblasts produce myofibroblasts due to mechanical stress (i.e weightlifting). Myofibroblasts are responsible for capsular contraction and shortening.
I hope you’re still with me…
So, imagine, you now have these cells which are constantly causing the shoulder to contract and shorten – can you now see why range of motion reduces and feels stiff? Honestly this still confuses me so I understand if you’re a bit lost.
We split Frozen shoulder into two categories:
1. Primary Frozen shoulder —> this one is annoying as we have no ides why it happens. We can speculate and try to figure out cause and effect although there is no evidence to support what actually causes primary frozen shoulder
2. Secondary Frozen shoulder —> Now in this case there are systemic, extrinsic, and intrinsic causes that can influence the progression of frozen shoulder.
Systemic = Conditions such as Diabetes
Extrinsic = Heart conditions/disease
Intrinsic = Rotator cuff tears, calcific changes at rotator cuff tendons
Who should be on the lookout for this condition?
Sorry ladies, but unfortunately you’re in the firing line for this condition. Women are 1.8 to 4.0x more likely to receive this diagnosis than males.
This condition is very uncommon in the young and elderly population with it being most prominent between the ages 40-65. We will talk about what other diagnoses can present similar to a frozen shoulder in future blog posts just know that if you’re not within this age bracket it’s unlikely you have a frozen shoulder.
Blood glucose has a causal effect of frozen shoulder so unfortunately individuals with diabetes are 5x more likely to have a frozen shoulder.
A history of heart disease, cancer, trauma to the shoulder/fracture, osteoarthritis, and rotator cuff tears are also risk factors for someones being diagnosed with this condition.
What your practitioner must do:
- Set realistic goals and expectations for the patient
- Re-assure the patient that the condition is self-limiting and will get better with or without treatment
- Provides the patient with education on the condition and guidance on rehabilitation
- Reduce any anxiety of fear the patient may have
Feel like you fall into some of the things I’ve described? Come in for a chat and we can work through this as a team 🙂
Written by Nick Dimakis (Chiropractor)