Adhesive capsulitis (frozen shoulder)

The shoulder is one of the most complex joints of the human musculo-skeletal system. The shoulder region connects the scapula, clavicle or collarbone and upper arm (humerus) and consists out of a number of soft tissue structures which enable its mobility and stabilize it during movement. Injuries and damages of the shoulder region can cause big problems with the functionality of the whole arm and by doing that they can impair the quality of life.

One of the most common shoulder problems is adhesive capsulits better known as frozen shoulder syndrome where shoulder mobility is significantly limited and impaired. The problem with this syndrome occurs in the joint capsule which surrounds the joint. The capsule starts developing scar like tissue which decreases its elasticity, limits the mobility of the joint and causes pain and stiffness during sleeping or while performing shoulder and arm movements. The background is an inflammation process of the joint capsule, but the surrounding soft tissue, shoulder ligaments and tendons, can also be impacted with time. Degenerative changes develop inside the joint capsule, it starts to swell and gets rigid which leads to a painful, limited and stiff movement. In the beginning stage there is only a feeling of stiffness and occasional pain which with time intensifies and increases the joint mobility limitations. An often occurence is muscle atrophy, loss of muscle mass due to inability to use the shoulder joint in the full capacity of its range of motion.

Exact causes of this syndrome are not known, but we do know that it is more common with women than men, that it occurs with people that have certain metabolic or hormonal disorders (diabetes, hipertireosis), individuals who are impacted with either an acute brain trauma or degenereative changes in their neurological functions (stroke, Parkinson`s disease) or with people who have cardio-respiratory problems.

Treatment of frozen shoulder is based on different physical and kinesitherapy methods. Physical therapy is aimed at reducing pain and joint capsule swelling and massage is used to reduce muscle stiffness. Kinesitherapy should implement progressive development of shoulder range of motion as well as strenght of posterior, anterior and lateral shoulder and upper arm muscles. Neck region should not be overlooked because it is in the close vicinity to the shoulder and its muscles often get stiff and overloaded because they are used more during arm and shoulder movements due to shoulder muscles being weakened.

Prevention: regular shoulder mobility and flexibility exercises, equal development of all shoulder muscle groups, especially of posterior (subscapular) muscles that often get overlooked in shoulder strenght development programs and are significantly weaker which leads to shoulder strenght deficits and causes problems with its functionality, etc.