With, Matt Silvaggio MSPT, CFMT
When a patient receives the diagnosis of a frozen shoulder from their physician or their physical therapist, it often leads to more questions than answers. Often, the condition that is actually being referred to when you hear the terms ‘frozen shoulder’ is the clinical condition known as adhesive capsulitis. What is the difference? A frozen shoulder is any condition of the shoulder that limits mobility, such as bursitis (the bursa or cushioning that protects the rotator cuff from the acromion bone above is irritated and inflamed from overuse). See figure. Adhesive capsulitis is a distinct condition where the mobility limitations of the shoulder are in a specific pattern, called a capsular pattern. This limitation in motion is traditionally thought to be the result of a tightening of the shoulder capsule from inflammation of the capsular tissue. The shoulder capsule is the first layer of tissue that surrounds the joint between the two bones of the shoulder (it is deep to the muscles). Current research continues to label this condition as self-limiting which can last for up to 2 years according to some sources.
So what leads to adhesive capsulitis? Science cannot say with certainty but it likely starts with an injured shoulder. This injury can be either traumatic or from a repetitive, unassuming injury. The onset of this condition has also be noted following prolonged periods of immobility such having your arm in a sling after an injury.
But medical literature demonstrates that the shoulder capsule is more than just a wrapping of tissue that can ‘tighten up’ as conventionally thought of with adhesive capsulitis or ‘frozen shoulder’. The shoulder capsule is filled with nerve endings called mechanoreceptors and proprioceptors. These nerve endings relay sensory information from inside and outside of the shoulder to the brain via the spinal cord and play a major role in the coordinated muscle activation patterns we use during healthy mobility. With a painful shoulder, the information from these nerve receptors can be overridden by the pain. The pain leads to suppression of the muscles necessary to stabilize the shoulder blade as well as the shoulder joint itself during activities like reaching and lifting overhead. Finally a vicious cycle is created of more pain, further neuromuscular dysfunction and limited shoulder mobility.
Your CFMT trained therapist can provide you the necessary treatment regimen using a combination of neuromuscular techniques known as PNF (proprioceptive neuromuscular facilitation) as well as soft tissue and joint mobilizations to help you break the cycle and not only abolish your pain but also help you get your shoulder mobility back. Without the proper guidance through this condition, the traditional model of looking at adhesive capsulitis as a self-limiting condition could be a reality.
Struyf F and Meeus M. Current evidence on physical therapy in patients with adhesive capsulitis: What are we missing? Clin Rheumatol. Decem 2013.
Myers J and Oyama S. Sensorimotor factors affecting outcome following shoulder injury. Clinics in Sports Medicine. 2008.Elite Health Services, located in Old Greenwich, (and now Westport!) CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services. Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care and delivering exceptional results. To learn more visit EliteHealthServices.com