An Overview on Frozen Shoulder and Adhesive Capsulitis
Frozen shoulder (FS) sometimes called adhesive capsulitis is a common shoulder condition that results in significant pain and loss of shoulder mobility. Sufferers often report shoulder stiffness in the early stages of this condition. Neglect of a stiff shoulder often leads to additional symptoms that include an inability to lift the arm to shoulder levels. The clinical teams of Chiropractic Specialty Center® are the experts you need for non-invasive recovery and repair of the damaged shoulder joint or tissues. The care you get from our teams of chiropractors and physical therapists is through manual and modality rendered procedures. The combination of advanced therapeutic devices and targeted manual treatments of a frozen shoulder syndrome (FSS) is the reason why our patients recover faster. So, if you are not keen on having injections or surgery for a frozen shoulder, visit one of our centers today.
Before going over our methods of shoulder treatments, it may be of help to many to discuss the issues that cause a frozen shoulder (FS) along with complications and its co-conditions. The most common question we get from our frozen shoulder patients is how did they get it. As mentioned, frozen shoulder is a loose term used to describe shoulder symptoms (FSS) such as shoulder pain and stiffness resulting in loose of mobility. In the most basic terms, a frozen shoulder develops when shoulder muscles and tendons are irritated, inflamed, damaged or torn. Initially, there is some pain or discomfort. But, some with mild shoulder injuries or damage may never experience any symptoms at all.
Before we get to an in-depth discussion or frozen shoulder, let’s go over some of the causes that lead to shoulder pain.
What are the Common Causes of Shoulder Pain?
Thoracic outlet syndrome, rotator cuff injuries, shoulder impingement syndromes, neck pain, slipped disc, upper back pain and pinched nerves are common causes of shoulder pain. Shoulder pain is more common than most think it is. It is a common health issue that causes loss of sleep, anxiety and even depression. What is worse is that many centers are ill-equipped or poorly skilled in accurate diagnosis and proper treatment of shoulder pain.
The pain in your shoulder could be the result of wear and tear of the soft tissues (muscles, tendons, and ligaments) that surround the shoulder joint. In addition to the soft tissues, the joint capsule and joint lining could produce severe pain. A slipped disc, spondylosis, bone spurs in the neck and degenerative discs disease are all known causes of shoulder pain. Complete recovery from shoulder pain is possible with targeted treatment that gets rid of the actual cause of pain. If you have shoulder pain, visit Chiropractic Specialty Center® today for the best non-surgical shoulder pain treatment in Malaysia. Trust our experts, experience, advanced therapeutic technology and non-invasive methods for faster recovery.
Is Adhesive capsulitis and FSS the same?
A common misconception amongst patients and some clinicians is that adhesive capsulitis is one and the same as FSS (frozen shoulder syndrome). Although these terms are used interchangeably, there are differences. In others words, they may describe similar symptoms, but the actual cause may be entirely different. As such, we believe that adhesive capsulitis differs from the FSS, and here is why:
Adhesive capsulitis is descriptive of issues that result from damage and degenerative changes of the shoulder joint; more specifically, the shoulder capsule. Since it impacts the joint directly; it is termed as primary adhesive capsulitis.
FSS, on the other hand, is usually a condition that results from damage or degenerative changes that occur near or in proximity to the shoulder joint. Often, these are the changes seen in the shoulder muscles and tendons. FSS usually results from damage and injury resulting in degeneration, inflammation or tears of the rotator cuff muscles or tendons. Since the damage is not in the joint or involving the joint capsule, a frozen shoulder is classified as secondary adhesive capsulitis. We have discussed both the primary and secondary causes of adhesive capsulitis in greater details in the coming sections as well.
What Causes Adhesive Capsulitis?
As mentioned, adhesive capsulitis and FS (frozen shoulder) are terms used interchangeably. There are differences as to the actual cause. However, the jury is still out on the actual cause of adhesive capsulitis and frozen shoulder. Some report it as an associated disorder to an autoimmune disorder. Most believe it to be due to an inflammatory process within the joint capsule. Others relate it to muscles, tendons and inflamed bursae of the shoulder griddle. But, the reality is that they all have merits. However, the most common cause of most FS or adhesive capsulitis is irritation or damage of the attaching soft tissues (ligaments, muscles, and tendons) and bursae (inflamed bursa or bursitis).
The shoulder joints are held together with attaching ligaments. Mobility is through the shoulder muscles and tendons. The bursa acts as lubricant and spacers for the tendons and muscles that surround the shoulder griddle. Irritation, damage or injury at any of these tissues can lead to degenerative a change that produces inflammatory processes, decreased mobility, and pain. If we break the term and look at them separately, it may become easier to understand:
- “Capsulitis” is an inflammatory process of the capsule or the shoulder socket.
- “Adhesive” is term denoting sticking, cementing or gluing together
Therefore, adhesive capsulitis as it stands is an inflammatory process that impacts the shoulder joint. In other words, the tradition or primary form of adhesive capsulitis is damage to the shoulder joint and shoulder socket. Muscle injury and tendons tears as seen in the rotator cuff issues are secondary forms of adhesive capsulitis. Let’s repeat that again, primary adhesive capsulitis is related to disorders within the joint capsule. Secondary adhesive capsulitis arises from rotator cuff issues or bursitis.
What is the Role of Damaged Joint Ligaments in Adhesive Capsulitis?
Joints are encapsulated. The term encapsulated as it pertains to joint addresses the soft tissues that surround, enclose or envelops a joint securely. The articulations in your shoulder are held firmly in place by shoulder joint’s capsule. This capsule is a collection of tissues and ligaments that firmly holds the joint together. The innermost parts of the shoulder capsule are made of membrane called the synovium. The synovium houses the synovial membrane is filled with synovial fluids. Synovial fluids are the needed liquid for lubrication and sustenance of cartilage and tissues within the shoulder joint.
Four articulation are make up the ‘shoulder joint. Direct or indirect traumatic events will impact the encapsulating tissues. It can lead to degenerative changes in the encapsulating ligaments. These degenerative changes are the leading causes of primary adhesive capsulitis better known as the frozen shoulder.
The degenerative changes associated with a frozen shoulder or primary adhesive capsulitis results in thickening of ligaments that hold the glenohumeral joint together. Hypertrophy is the term used to describe the thickening in ligaments. In short, hypertrophies are scar tissues or adhesions. The presence of these adhesions in the shoulder joint creates pain, stiffness and an eventual loss of motion. In time, the shoulder losses the mobility it once had.
Conditions that lead to thickening of the shoulder capsule will cause a decrease in production and availability of synovial fluids. With decreased production of synovial fluids, the joint degenerative and tissues start to break or tear apart within the joint. Thee change will impact joint mobility significantly. Pain can be severe and excruciating. Daily activities such as brushing teeth, combing the hair or just putting off a shirt become a daunting task.
What are the Common Symptoms of Adhesive Capsulitis?
Loss of mobility and pain with shoulder movements are classic symptoms in the frozen shoulder (adhesive capsulitis). As mentioned, frozen shoulder if often caused by either injury or degenerative changes that take place over time. Some believe the common cause could be spontaneous, but we disagree. Any symptoms or pain you experience has a purpose or reason. In the so-called spontaneous cases, premature degenerative changes are the leading factors.
The development of adhesive capsulitis may also be due to a secondary condition including neck issues, upper back issues, rheumatoid diseases, heart disease, adrenal issues, thyroid problems, and even recent shoulder surgery.
Yes, if you have had a frozen shoulder after shoulder surgery, you are not alone. In fact, it is somewhat familiar and often implicated as leading cause of the primary adhesive capsulitis. The degree of damage and severity are often linked. A common complaint is frozen shoulder patients is lack of sleep. Lack o sleep is usually due to severe pain that wakes you up in the middle of the night.
As it progresses, other motions may also become difficult. In chronic cases, rotational movements are limited or absent. An inability to grasp the top of the opposite shoulder or reaching behind (internal rotation) is common occurrences in neglected cases. Frozen shoulder or adhesive capsulitis symptoms are often linked the ball-and-socket joint of the shoulder but can implicate other joints of the shoulder.
How many joints are there in the shoulder?
The shoulder is the most mobile joint in the body. No other articulation has the same or similar ranges of motion as the shoulder does. The shoulder’s increased mobility is due to its shallow joint surfaces, encapsulating ligaments and of course the muscles that provide mobility. Another reason for increased mobility is the number of joints that allows for this motion. The shoulder joint is not a singular joint, but a series of four joints working collaboratively to provide the mobility we need for daily life. We have submitted a brief list of these joints below for your review:
- The Glenohumeral Joint: The shoulder joint is a shallow ball-and-socket” joint that forms when the ball of the shoulder bone (humerus) sits or rests in the cup-like surface of the shoulder blade (glenoid fossa of the scapula).
- AC or Acromio-Clavicular Joint: The clavicle is the collarbone. It connects to the sternum at the midline and the tip of the scapula (Acromion Process) at the shoulder joint.
- The Sterno-Clavicular Joint: As mentioned the midline attachment of the collarbone to the sternum (breastbone) is called the sternoclavicular joint.
- Scapulothoracic joint: The scapulothoracic joint is formed by the shoulder blade (scapula) meets or comes in close approximation to the ribs in the upper back.
Are there Different Types of Adhesive Capsulitis?
There are two main categories of frozen shoulder or adhesive capsulitis:
- Primary Frozen Shoulder (True Adhesive Capsulitis)
- Secondary Adhesive Capsulitis or Frozen Shoulder (True Frozen Shoulder)
As mentioned numerous times before, frozen shoulder and adhesive capsulitis are terms used interchangeably with differences in etiology. What we mean by that is that while there are many similarities, they differ in the actual cause.
What is the Actual Cause of Primary Adhesive capsulitis?
Primary or TRUE Adhesive Capsulitis is a condition related to other diseases. In other words, another health condition was the reason why adhesive capsulitis emerged. The most common co-conditions that could result in adhesive capsulitis include autoimmune disease (such as rheumatoid arthritis), diabetes, heart disease, stroke, Parkinson’s, hypothyroidism, lung diseases, and even shoulder surgery or neck dissection. In fact, published research reports the prevalence of adhesive capsulitis at 20% in patients with diabetes. Patients with the primary adhesive capsulitis (secondary frozen shoulder) will complain of pain and loss of mobility.
The classic differentiating symptom between the primary and secondary forms of frozen shoulder is the loss of rotation. Primary adhesive capsulitis, patients will initially present with limitation in external rotation. However, patients with TRUE FSS (Frozen Shoulder Syndrome) or secondary adhesive capsulitis often complain in loss of internal rotation initially.
What are the Causes of TRUE FSS or SECONDARY Adhesive Capsulitis?
The SECONDARY adhesive capsulitis or “true frozen shoulder syndrome” (FSS) is often due to damage or degenerative changes in the major shoulder muscles and tendons of the rotator cuffs. Conditions such as rotator cuff tears, bursitis, tendonitis, or bone spurs (Acromio-Clavicular spurs) are common causes of the secondary adhesive capsulitis or a “true frozen shoulder syndrome” or FSS.
The rotator cuffs are a group of four muscles that help mobility and keep the shoulder joint stable. The four significant mobilizers or stabilizers of the shoulder are:
- Supraspinatus muscle
- Infraspinatus muscle
- Teres minor muscle
- Subscapularis muscle
Of the four muscles, the supraspinatus muscle and its tendon is the most commonly injured tissue. The supraspinatus tears are usually seen at the tendinous attachment to the greater tubercle of the humeral head. Often times, the cause of this tear is an enlarged bone spur at the AC joint (acromioclavicular joint). As mentioned, the rotator cuffs are responsible for shoulder mobility and stability. These four muscles are the primary abductors (lifts the arm up), internal rotator and external rotator of the shoulder. For most patients, minor or initial tears of the rotator cuffs are painless. As such, it often goes undetected. However, as it progresses it can cause symptoms.
How is the Primary Adhesive Capsulitis Differentiated from a Secondary Adhesive Capsulitis or FSS?
Again, there are differences between primary and secondary forms of adhesive capsulitis. The secondary adhesive capsulitis or the “true frozen shoulder syndrome” (FSS) is related to damage, irritation or injury of the rotator cuffs, bursae or emerges for arthritic changes in the associated shoulder joints. Although similarities are significant, our expert non-surgical clinical teams use a variety of means to distinguish the differences. Identifying the actual cause of shoulder pain is the critical step in recovery. In other words, it is imperative to distinguish primary adhesive capsulitis from a secondary or the “true frozen shoulder syndrome” or FSS.
Earlier we mentioned that patients with a true FSS would present with limitation in internal rotation and those with primary adhesive capsulitis often have limitations with external rotation. Wee, there is another sign to help distinguish the two. A “true frozen shoulder” patient will present with difficulty in the passive abduction and internal rotation. Shoulder abduction is the motion where you lift your shoulder sideways, towards the head and neck. Internal rotation is the motion where one tries to reach their behind. Active range of motion one where the patients attempt movements. Passive ranges of motions are the fully assisted movements. In other words, the patient remains still, while the clinician or therapists move the arm.
In short, the loss of passive ranges of motion are the classic signs of a “true frozen shoulder syndrome” (FSS) better known as the secondary adhesive capsulitis. On the other hand, the primary adhesive capsulitis patient will have difficulty in both active and passive ranges of motion. Another means of differentiating the cause is through diagnostic imaging. The best modality to diagnose adhesive capsulitis is the MRI.
MRI or Magnetic Resonance Imaging is the Gold Standard in Shoulder Assessment
X-rays and diagnostic ultrasound have had some successes in the assessments of shoulder pain. But, none has proven as helpful as the MRI. Magnetic Resonance Imaging (MRI) can detect tears in muscles or tendons. It is also the best modality in assessing bone spurs, cartilage, joint capsule, ligaments and even pathology. In short, if you have shoulder pain that won’t go away, you should ask your doctor for MRI. The chiropractors and physiotherapists of Chiropractic Specialty Center® are the best non-surgical experts when it comes to diagnosing and treatments of shoulder pain. Our clinical teams have the knowledge needed to identify the actual cause of your shoulder pain.
In our center, a Doctor of Chiropractic will thoroughly assess your shoulder. We will also evaluate your neck, upper back, and chest (ribcage) to identify the cause before treatments. Often, there are multiple causes. Recovery is possible with our targeted care that addresses the actual cause. The care you get from us is through the best chiropractors and physiotherapists in Malaysia. Our method of care and treatments used for a frozen shoulder will get you back to active life faster. Call us now.
What is the Best Treatment for Adhesive Capsulitis or FSS?
Spine, joints, and sports injuries are best treated through conservative methods. For conservative treatments to work, care must be targeted to tissues damaged or irritated. Adhesive capsulitis or FSS (frozen shoulder syndrome) treatments depend on the actual cause. Both primary and secondary causes of adhesive capsulitis are in need of conservative treatment. However, primary adhesive capsulitis patients will require care from other specialists in tandem with the treatments we provide. Our clinical physiotherapists and advanced chiropractors will inform you of this need should it arise.
In both the primary and secondary forms of frozen shoulder, soft tissues, joints, and cartilage of the shoulder joint are affected. The care you get from us will address these issues through physiotherapy, targeted chiropractic treatments, and supplements. Depending on the cause and severity of damage, our clinical teams may use shockwave therapy, ultrasound, electrical stimulation, myofascial release, trigger point therapy, or targeted exercise rehabilitation. In most cases, we use several methods to address the underlying issues.
The hallmark frozen shoulder is the loss of mobility. With decreased mobility, the shoulder joint weakness. This weakness will result in degenerative changes and tears in critical tissues. Our goals are to identify and correct them without injections or surgery. In short, if you are not keen on having shoulder injections or shoulder surgery, visit a Chiropractic Specialty Center® near you today. Our center provides holistic non-invasive frozen shoulder treatment in Malaysia.