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What are the symptoms of Frozen Shoulder (Adhesive Capsulitis)?
The two main symptoms of frozen shoulder are pain and persistent stiffness in the shoulder joint. This condition causes discomfort and limits the shoulder's range of motion, making daily activities challenging and affecting the quality of life for those affected.
Symptoms can sometimes be similar to others and mixing up the diagnosis can set you back in your recovery. Here are some good ways to recognize the differences between frozen shoulder and a rotator cuff tear:
- Movement: With a rotator cuff tear, you may have some pain when moving your arm in certain directions, but you should still be able to lift it on your own. Frozen shoulder, on the other hand, severely limits your range of motion. Lifting your arm on your own becomes difficult or even impossible.
- Pain: Both conditions can cause pain, but they often feel different. Rotator cuff tears typically cause a sharp or aching pain, often worse at night. Frozen shoulder pain can also be aching, but it tends to be more constant. In the early stages of frozen shoulder, pain may be the most prominent symptom.
- Stiffness: Frozen shoulder is known for its stiffness, which worsens as the condition progresses. Your shoulder may feel stuck, making even small movements difficult. Rotator cuff tears can cause stiffness too, but it's usually not as severe as with frozen shoulder.
The stiffness and tightness in the shoulder capsule from frozen shoulder restrict the arm's movement. To compensate for this limitation, the body might rely more on the muscles surrounding the shoulder blade to try and achieve some movement. This can lead to imbalances and potential pain in the scapular muscles (shoulder blade).
What are the 3 stages of Frozen Shoulder?
Frozen shoulder, also known as adhesive capsulitis, involves the gradual thickening and tightening of the shoulder capsule, leading to the development of thick bands of tissue called adhesions. According to the American Academy of Orthopaedic Surgeons, this often coincides with a reduction in synovial fluid within the joint.
The condition progresses through three stages, each marked by distinct characteristics:
Freezing State: Six weeks to nine months
- During this initial stage, individuals grapple with the progression of pain. The discomfort steadily increases, causing distress and making daily activities challenging.
- A noticeable reduction in the range of motion within the affected shoulder will be noticed. This limitation introduces frustration and vulnerability.
Frozen Stage: Four to six months
- The Frozen Stage epitomizes the peak of the struggle, typically lasting between four to six months. At this point, the shoulder joint experiences near-complete or complete immobility, further confining the individual to discomfort.
- A disheartening aspect of this stage is the inability to move the arm voluntarily. Self-mobility is severely limited; others also find it challenging to manipulate the frozen shoulder. The reliance on external assistance for even the most basic movements adds a layer of emotional strain to the physical burden.
Thawing Stage
- A glimmer of hope emerges during the Thawing Stage, promising gradual recovery. This phase typically commences five to fifteen months after the initial onset of frozen shoulder.
- Mobility starts to return as the stiffness begins to dissipate. The affected individual may find relief in witnessing the gradual restoration of their shoulder's range of motion. However, it is essential to approach this phase with patience and understanding, as the pace of recovery can vary from person to person.
- Full muscle strength and range of motion recovery may take up to two years. This period calls for perseverance and unwavering commitment to rehabilitation exercises and therapies as the shoulder regains its former strength and flexibility.
How to diagnose Frozen Shoulder
Diagnosing frozen shoulder involves a physical exam and a medical history review by a healthcare professional. Symptoms such as shoulder pain, stiffness, and limited range of motion indicate the condition. Imaging tests such as X-rays may be used to rule out other shoulder disorders.
1. Medical History Review
The diagnostic process often begins with a detailed review of the patient's medical history. The healthcare provider will inquire about any previous shoulder injuries, medical conditions, or surgeries that may contribute to the development of frozen shoulder. Additionally, they may ask about the onset and progression of symptoms, including shoulder pain, stiffness, and limitations in range of motion.
2. Physical Examination
A detailed physical examination is necessary for evaluating shoulder function and identifying specific signs associated with frozen shoulder. During the examination, the healthcare provider will assess:
- Range of Motion: The ability to move the shoulder joint in various directions, including forward flexion, abduction, external rotation, and internal rotation.
- Strength and Stability: Any weakness or instability in the shoulder muscles and ligaments.
- Tenderness: Areas of tenderness or pain around the shoulder joint.
- Capsular Patterns: Specific shoulder movement restrictions characteristic of Frozen Shoulder, such as decreased external rotation compared to internal rotation.
3. Diagnostic Tests
While physical examination findings are necessary to diagnose frozen shoulder, additional diagnostic tests may be ordered to confirm the diagnosis and rule out other shoulder conditions. These tests may include:
- Imaging Studies: X-rays are commonly performed to assess the bony structures of the shoulder joint and rule out fractures or degenerative changes. Magnetic Resonance Imaging (MRI) or ultrasound may also visualize soft tissues, including the joint capsule and surrounding structures.
- Arthroscopic Examination: In some cases, arthroscopic surgery may be recommended to directly visualize the inside of the shoulder joint and confirm the presence of adhesive capsulitis. This minimally invasive procedure involves inserting a small camera (arthroscope) through tiny incisions in the shoulder to assess the extent of joint inflammation and scar tissue formation.
Diagnosing frozen shoulder requires an approach that combines medical history review, physical examination, and diagnostic testing.
