Frozen shoulder, adhesive capsulitis, or something else?
Frozen shoulder, is a term coined in 1934 by American Dr E Codman, describing a condition that he regarded as ‘difficult to define, difficult to treat and difficult to explain from the point of view of pathology’.
Eleven years later Dr JS Nevasier came up with the more medical-sounding ‘adhesive capsulitis’ after he observed ‘adhesions’ (tissues stuck together) in the ‘capsule’ (inside) of the shoulder joint. Since then this has become the catch-all medical diagnosis for restricted movement and shoulder pain, although no clinical tests exist and as few as 10% of frozen shoulder cases are caused by actual adhesions in the shoulder joint.
Science writer Paul Ingraham has offered the term ‘contracted shoulder’, but I suggest the term ‘restricted shoulder’ more accurately covers both joint adhesions and the main cause of frozen shoulder – subconscious guarding.
Most people who develop frozen shoulder do so after another injury such as a broken arm, muscle tear, or tendon damage; often exacerbated by poor posture. The shoulder contracts into itself, and the body subconsciously shuts down movement to guard against further damage. This then develops into a neurological inhibition in which even a small amount of movement causes pain.
Typical symptoms of restricted shoulder include reduced range of movement, constant deep aching, sleeplessness, and sharp pain on sudden movement. Restricted shoulder develops through three phases – ‘freezing’, ‘frozen’, and ‘thawing’ – over 2 to 5 years. During this time inappropriate or unnecessary medical treatment can escalate from painkillers to anti-inflammatories, to steroid injections and forced manipulation of the shoulder joint under anaesthetic. Results are varied and often similar to, or worse than, doing nothing at all.
Restricted shoulder occurs because of restrictions that develop in the fascia, the main connective tissue in the body. In response to injury or disuse, fascia tightens and solidifies. And, as fascia contains more nerves than any other body tissue, the sensation of pain is caused by tight fascia squeezing on nerves.
The shoulder joint is normally the most mobile in the body, consisting of a shallow ball and socket joint supported by 24 muscles, 17 attached to the shoulder blade, and all connected by lots of fascia. However, as Dr Janet Travell observed over 50 years ago, virtually all common symptoms experienced in frozen shoulder / restricted shoulder come from myofascial trigger points in just one muscle – the subscapularis. This is one of the rotator cuff muscles, attached to the underside of the shoulder blade. Treat the subscapularis with myofascial release and much of the pain of restricted shoulder can be resolved.
Simultaneously, regular self-help can encourage movement to return. This need not be arduous. Helpful movement can be anything within your comfortable or ‘good pain’ range.
If you really can’t move your shoulder at all without pain, then just imagine moving it. By imagining your shoulder moving freely and pain-free you can help persuade your brain to let your shoulder move again.
Contact Pain Care Clinic for myofascial treatments and self-help for frozen shoulder aka restricted shoulder.