Older athletes are more prone to suffer from the frozen shoulder syndrome, also referred to as adhesive capsulitis. Frozen shoulder is a condition that affects the shoulder joint capsule; a fibrous covering of the synovial lining of the shoulder joint. When the capsule becomes inflamed, it results in pain and significant stiffness of the joint. Due to these symptoms, the athlete quickly demonstrates a characteristic limitation in the range of motion of the shoulder.
These restricted motions occur with both active and passive range of motions.
Active Motion: When the individual moves the joint with his own muscles.
Passive Motion: When someone or something else moves the joint with no active involvement by the individual.
Individuals between the ages of 40 and 60 make up a majority of those diagnosed with this injury while more women out number the men. Interestingly, adhesive capsulitis is also more common with individuals previously diagnosed with diabetes. Shoulder pain is usually constant and aggravated by weather changes, keeping the joint in one place for too long and activities that create excessive shoulder movements.
Common Causes of Frozen Shoulder
- Prolonged Immobilization: Secondary to a rotator cuff injury, arm fracture, post surgery immobilizations, stroke, …etc.
- Premorbid status: Athletes already dealing with certain systemic diseases such as diabetes, abnormal thyroid functions, tuberculosis, and chronic heart abnormalities.
- Any injury to the shoulder can lead to frozen shoulder, especially ailments that produce excessive inflammation such as tendonitis, bursitis, and inflamed rotator cuff muscles/tendons. The four muscles that form the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis.
Typically course of a frozen shoulder syndrome: Can be descriptively broken into three phases. Each phase could last from a few weeks to almost a year.
1) The “Freezing” Phase: The individual/athlete slowly starts to develop tolerable pain and stiffness around the shoulder joint. Range of motion reduces almost directionally proportional to increasing levels of pain. Some range and strength lost is due to subconscious suppression of active movement secondary to pain. The discomfort is often worse at night and especially when you lay on the affected side.
2) The “Frozen” Phase: The inception of this stage is marked by a cessation of increasing pain, which the athlete subconsciously perceives as a decline in pain. Meanwhile, the stiffness and reduced range of motion remains compromised, regular routines remain difficult during this phase, and muscle wasting (atrophy) becomes more evident. The frozen phase could last for about four months to a year. Rotation of the arm outwards (external rotation) can become very difficult in this stage.
3) The “Thawing” Phase: Also called the recovery phase. Shoulder range of motion starts to improve. Strength and functional capacity are gradually regained. This phase can lasts a 2-3 months.
Signs and Symptoms of a frozen shoulder
- The shoulder suddenly becoming increasingly stiff/immobile and painful around the joint. Dull aching pain occurs with motion and at rest.
- Shoulder girdle stiffness restricts full range of motion with both active and passive movements.
- Localized pain over the outer shoulder area and upper arm.
- Sleep deprivation and possible transient insomnia.
Professional Treatment for frozen shoulder/Adhesive capsulitis
- Intermittent icing with immediate range of motion exercises. This will help decrease pain and regaining range of motion while the surrounding tissue is “numb” from the ice.
- Working directly with a physical therapy is very helpful for adhesive capulitis.
- If prescribed by a physician, anti-inflammatory medications made be helpful when taken immediately prior to your rehab sessions.
- Gentle stretching exercises to increase shoulder girdle range of motion.
- Persistent motion of the shoulder joint during activities of daily living to help maintain motion.
- In cases where an aggressive rehab plan is ineffective or the limited range of motion becomes too excessive, the physician may recommend a manipulation of the shoulder joint performed under general anesthesia to break up the adhesions/tightness.
Asking the Right Questions like a Pro Athlete
Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:
- Could be this be a secondary complication of arthritis or another injury involving my shoulder joint?
- Do you think that I need an MRI to rule out other possibilities?
- What is a realistic outcome for me with this injury?
- Where is the best place in this area to rehab this injury?
- How soon can I return to my normal activities?
Elite Sports Medicine Tips from Mike Ryan
- Good news – A frozen shoulder is rarely associated with any cancerous pathologies.
- Take Rehab Seriously– Be proactive with your physical therapy. The success of your rehab will dictate the use of your shoulder for the next 1-2 years, period.
- Simple Formula – Reduce inflammation while re-programming the muscles that move the shoulder joint.
- One Timer – Once cured, it almost never comes back.