Adhesive capsulitis or frozen shoulder has different causes, but before we get into that, let’s look at the two types of frozen shoulder.
The Two Types of Frozen Shoulder
Frozen shoulder can be classified into two types: primary frozen shoulder and secondary frozen shoulder.
- The primary frozen shoulder does not have an initiating event or cause. Roy (2012) suggested that specific genetic abnormalities may attribute to frozen shoulders. Cultures of the tissue obtained from the glenohumeral joint capsules of patients with frozen shoulders revealed aberrations involving chromosome 7 or 8 in the fibroblasts.
- Secondary frozen shoulder is often linked to a significant event, such as trauma, surgery, illness, or infection. Overall, any condition affecting the shoulder that results in inflammation of the joint capsule causes a secondary frozen shoulder. This causes scar tissue formation, thickening, and the eventual shrinkage of the capsule that envelopes the glenohumeral joint. These changes leave less room for the humerus to move, thus, limiting the movement of the joint.
Any injury involving the shoulder joint may cause a frozen shoulder. The outcome of these changes in the shoulder causes pain and tightens and restricts the joint’s movement.
Shoulder Injuries that Cause Frozen Shoulder
The following injuries have been associated with frozen shoulder:
- Shoulder tendinitis. This frequently involves inflammation of the biceps tendon or rotator cuff tendon. Tendons are tough fibrous tissues that connect a muscle to a bone. The tendon is usually red, sore, and swollen in this condition. An injury, overuse of or repetitive shoulder motion, tendon infection, or chronic tendon inflammation, which could occur with rheumatoid arthritis, commonly causes shoulder tendinitis.
- Shoulder bursitis. As previously discussed, the bursa is a sac-like structure that functions as a cushion between bones and tendons. Synovial fluid lubricates the articulating joints and fills the bursa. This fluid-filled sac also serves as a shock absorber between bones and muscles around the joint. Shoulder bursitis involves inflammation of the bursa in the shoulder joint. An injury, an underlying rheumatic condition, or infection may cause bursitis.
- Rotator cuff injury. This mainly involves irritation or damage to one of the four muscles making up the rotator cuff. An injured or damaged rotator cuff tendon may lead to frozen shoulder symptoms. These muscles work as a unit to further stabilize the shoulder joint, assisting the shoulder as it moves in different positions. Inflammation of the rotator cuff tendon, impingement of any of the four muscles of the rotator cuff, or tearing of the rotator cuff tendon causes rotator cuff syndrome.
Shoulder injury typically involves pain. Pain limits movement of the affected shoulder and may impede an individual from performing their usual routine. Prolonged immobilization has been connected to the frozen shoulder. The incidence of frozen shoulder is higher in patients with diabetes, especially those dependent on insulin. Sports Injury Clinic (2012) suggests that excess glucose molecules stick to the collagen fibers in the joint capsule, contributing to joint stiffness.
Diagnosis and Prognosis of Frozen Shoulder
Diagnosing Frozen Shoulder
Frozen shoulder syndrome is diagnosed by a physician who performs a complete medical history and conducts a thorough physical examination. The physician usually orders a magnetic resonance imaging or ultrasound to examine the soft tissues of the shoulder, such as the rotator cuff, or to get a deeper understanding of the injury. Patients with signs and symptoms of frozen shoulder are often referred for an x-ray of the shoulder.
Common Outcome for Frozen Shoulder
The prognosis (probable outcome) for patients with frozen shoulder syndrome who receive the proper treatment is generally favorable. Often, the first treatment options are physical therapy, frozen shoulder exercises, and conservative modalities described in the next section, which positively affect the frozen shoulder. Without consistent and aggressive treatment, the effects of a frozen shoulder can be permanent (Shiel, 2011).
Rick Kaselj, MS.
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