Frozen Shoulder: Shoulder Injury, Shoulder Joint Pain, Adhesive Capsulitis

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Frozen Shoulder – Adhesive Capsulitis:
Reduced Range of Motion in the Shoulder Joint Capsule

Adhesive Capsulitis - Adhesions in the Joint Capsule

Frozen Shoulder, not to be confused with Shoulder Impingement Syndrome, occurs as the result of a shoulder injury to the shoulder joint capsule. The injury could be related to the Rotator Cuff, bursitis, or even tendinitis. Shoulder injuries of this nature result in a considerable amount of shoulder joint pain.

The “freezing” process that occurs

When the shoulder joint capsule is injured, a considerable amount of inflammation occurs. The inflammation causes the body to build up scar tissue in the shoulder joint capsule. That scar tissue becomes thicker and thicker over time. As the scar tissue builds up, the shoulder joint capsule becomes smaller and smaller. As the shoulder joint capsule becomes smaller and smaller, its begins to “stick” or adhere to the head of the Humerus, the bone in the upper arm that begins at the shoulder and ends at the elbow. The end result of the adhesion and smaller shoulder joint capsule is not only sever e pain, but a severe range of motion reduction.

Frozen Shoulder Introduction

Okay so I think I have Adhesive Capsulitis, what now?

Shoulder Impingement Syndrome is a similar condition, so we need to have a Frozen Shoulder Assessment performed in order to distinguish one from the other. Bursitis, tendinitis, or arthritis could also mimic Adhesive Capsulitis.

What should the medical history tell me?

The medical history portion of the Frozen Shoulder Assessment should tell us that the shoulder received some kind of trauma or injury that resulted not only in pain, but in limited mobility over a period of time. Numerous questions any kind of shoulder or neck trauma need to be answered, especially because neck trauma can be directly related to shoulder pain or injury. We need to be able to dismiss any other type of occurrence such as arthritis or bursitis to consider the elimination of unrelated causes. If these questions about past medical history are not asked, they will not likely be answered at all.

Were there any Imaging Diagnostics taken?

Arthography can help the diagnosis. It is the process of injecting a special dye into the shoulder joint and taking an x-ray of the dye–injected shoulder to reveal a shrunken shoulder joint capsule.

Utilize a Pain Scale Map to get a Visual Representation of Pain Scale Levels and Representation.

The Pain Scale Map is a visual map of a illustration representing the human body. There should be a Legend of symbols that represent different forms of soft tissue dysfunction and joint position such as Spasm, Trigger Point, or Rotation and Elevation, as well as pain scale levels. A 0-4 pain scale indicates a pain experience at a functional level. A pain scale of 5-7 indicates pain at an uncomfortable level. When the pain scale hits 8-9, that is a level of pain that causes a person to become bed-ridden. Unbearable pain is when the pain scale hits 10. The diagram should then be mapped with the appropriate symbol, pain scale and location

What makes the pain better or worse?

Ask about what movements make the pain better or worse, and how the movements increase the pain, if the pain is continuous or intermittent, and what time of day the pain is at its worst and what has or has not been done to decrease pain.

Are there any Visual Symptoms I can expect to see, and what can I do to reveal them?

It would be difficult to tell if a person has Adhesive Capsulitis just by looking at it. Visual signs of swelling are not normally associated with frozen shoulder, but if any kind of atrophy is seen, that is something that needs to be looked at further.

What should the affected areas feel like when palpated?

Palpate the shoulder area before and after the Range of Motion Testing. Check for individual temperature, tone, pain and tenderness surrounding the entire shoulder. Increased temperature indicates possible inflammation; decreased temperature is more in tune with frozen shoulder related to poor circulation due to decreased mobility and the effect upon the nerve structures. Muscle tissues should be supple, because hypertonicity or flaccid tissues indicate possible circulatory or nerve related problems. Don’t forget to check around the border of the Scapula as well. Check to see if Trigger Points are present in the soft tissue structures.

Range of Motion for Frozen Shoulder Assessment will help us to discover where the problem is.

Range of Motion Testing is the foundation of the Frozen Shoulder Assessment. It will tell us if the shoulder joint capsule is restricted and exactly how it is restricted. If this process is not undertaken, the resulting treatment will be a shot in the dark.

Shoulder Pain Assessment and Examination

What Frozen Shoulder Assessment Range of Motion Tests should I be doing?

Active(AROM), Passive(PROM), as well as Resisted Range of Motion(RROM) Testing for both shoulders should be performed as well as the neck. We must specifically determine the movements that exacerbate pain, how the pain scale for each movement is affected, the ROM for each movement in terms of degrees of range of motion, and the quality of the movements as to whether the movement is smooth, segmented, spastic, or rigid. Why both shoulders? You need to be able to make a comparison between the affected shoulder and the shoulder that should be functioning normally. Why the neck? It has been my experience that Brachial Plexus Nerve Compression, a Thoracic Outlet Syndrome component, is frequently associated with Frozen Shoulder. If this is happening, any type of shoulder treatment is severely limited if this is not addressed first.

What else should we look out for?

We must absolutely check for proper Movement of the Scapula because restricted scapular movement can fool us into believing that Adhesive Capsulitis is in play. Check for elevation, depression, protraction, retraction.

Please click on the link below for information about Frozen Shoulder Treatment.

Frozen Shoulder Treatment Restoring Range of Motion to the Shoulder Joint Capsule
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Frozen Shoulder – Adhesive Capsulitis: Reduced Range of Motion in the Shoulder Joint Capsule

Frozen Shoulder – Adhesive Capsulitis:
Reduced Range of Motion in the Shoulder Joint Capsule