Now that you’re here it’s going to be helpful for your online research to know that the medical term for frozen shoulder is Adhesive Capsulitis or Ad Cap/AC for short. This is a helpful label for the condition because this is exactly what the problem is – the capsule of the shoulder joint is inflamed, and sticky. At the peak of the condition the capsule is so tight that the bones inside the capsule can’t move – your shoulder joint is FROZEN! Its like putting on a wetsuit that’s 10 sizes too small. You just can’t move.

But do you have Adhesive Capsulitis?

The people who are most likely to develop Ad Cap are:

• Female

• In your 50’s & 60’s

• Have type 1 diabetes

If we consider all the people who present to a healthcare practitioner with a shoulder problem, Ad Cap is not that common. Around 2-5% of the population will have AdCap in their lifetime whereas 9.7-62% of the population will have a rotator cuff related problem.

Shoulder impingement syndrome is the most common of all shoulder problems. 44-65% of all shoulder problems are impingement.

But just because it’s not that common out of all the possible shoulder problems doesn’t mean you don’t have it.

We know that people with Ad Cap experience pain and stiffness in their shoulder which gradually gets worse over 6-9 months. During this time it can be very painful to move the shoulder joint and there can be pain at night. The only problem with this is that this is exactly what people with rotator cuff problems and shoulder impingement complain of too!

Herein lies the problem that clinicians face when trying to diagnose someone’s shoulder problem. That said Ad Cap is most often diagnosed through physical examination and doesn’t rely on imaging.

In the clinic room I will be thinking along these lines:

• Has there been a traumatic event in this person’s life (mental or physical)? Sounds odd but I’ve seen cases of frozen shoulder that look like they were triggered by a death in the family or a particularly stressful period at work. Don’t forget – we still don’t really know what triggers Ad Cap but we do know that stress and stress hormones can effect every single system in our body. Psychoendoneuroimmunology is the study of this if you don’t believe me.

• Is there a history of injury or an operation in that shoulder? This makes Ad Cap a little more likely but it also makes rotator cuff dysfunction and impingement more likely

• When the elbows are tucked into the waist with the elbow at 90 degrees, keeping the elbows tucked in to the sides can the patient swing their hands outwards so they are moving away from each other? If the answer is no then Ad Cap is more likely. This shows that the capsule is stopping the bones at the shoulder joint from moving.

• Does this person have arthritis elsewhere in the body?This could indeed be arthritis in the shoulder joint. Is the arthritis in the spine (neck and upper back) leading to postural changes which are causing shoulder impingement?

• Has this person used their arms in such a way over their lifetime and career which makes impingement more likely? Certain occupations matched with certain people equal shoulder problems. Thinking about the way you have used your body up to this point might give you some clues as to what’s lead you to this point.

• Is the pain getting progressively worse or does it ease a little bit once they’re up and moving about? In the first few months Ad Cap will get worse and worse but rotator cuff problems and impingement are more likely to plateau or get a little better.

Could we just scan it? Wouldn’t that just give us the answer straight away?

X Ray will not show Ad Cap because it is a soft tissue condition and x rays are designed to show bones the best.

Ultrasound might show some signs of Ad Cap but is more likely to rule in or out other problems such as rotator cuff tears

MRI can show ligament thickening and synovial thickening which are associated with Ad Cap.

It could be argued that if you’re not a surgical case (i.e your pain and disability have become unmanageable or your case of Ad Cap is taking much longer than average to resolve by itself) then it’s not worth exposing you to radiation because having an MRI scan showing Ad Cap in your shoulder won’t change anything for you. You would still be prescribed pain killers, you would still be advised to have physical therapy (osteopathy/physiotherapy).

I hope this has been of some help to you. Please get in touch if you have further questions and I’ll be happy to advise as much as I can.

Where did I get the information in this blog from?

My own clinical experience with patients

The NHS website

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474834/

https://www.webmd.com/a-to-z-guides/what-is-a-frozen-shoulder#1

https://journals.sagepub.com/doi/pdf/10.1177/201010581402300406

Kelley, M. J., Shaffer, M. A., Kuhn, J. E., Michener, L. A., Seitz, A. L., Uhl, T. L., et al. (2013). Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. Journal of Orthopaedic & Sports Physical Therapy, 43(5), A1–A31. http://doi.org/10.2519/jospt.2013.0302

MD, T. T., BSc, B. L., BSc, B. T. R., & PhD, D. R. M. (2014). A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery, 23(12), 1913–1921. http://doi.org/10.1016/j.jse.2014.08.001

Struyf, F., & Meeus, M. (2013). Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing? Clinical Rheumatology, 33(5), 593–600. http://doi.org/10.1007/s10067-013-2464-3

van der Windt DAWM, Koes BW, De Jong BA, Bouter LM. Shoulder disorders in general practice: Incidence, patient characteristics and management. Ann Rheum Dis 1995;54(12): 959–64 doi: 10.1136/ard.54.12.959.