Frozen Shoulder Also Known As “50 Year Old Shoulder”
Known as “50 year old shoulder” in Japan, a frozen shoulder is a very painful condition, something which typically but not exclusively occurs in middle age. A relatively poorly understood condition with regard to the cause, a frozen shoulder usually occurs spontaneously, however suffering a frozen shoulder is something that is relatively common following surgery, trauma to the upper extremity, or significant stress.
What Is A Frozen Shoulder?
Adhesive Capsulitis is another term that has commonly been used medically to refer to a frozen shoulder, adhesive capsulitis refers to the former belief that the condition and movement restriction was the result of an adhered (stuck) capsule of the shoulder joint to the bone. The condition is characterized by significant and painful restriction of shoulder motion in the presence of a normal X-ray (or absence of any other actual shoulder disorder). In a frozen shoulder the capsule which can be likened to a sleeve that covering the joint becomes inflamed and thickened causing restricted range of motion and pain. Initially, pain is severe often presenting as a vague diffuse pain in the shoulder and upper arm, but this may may spread as far as the wrist and hand in some individuals. Individuals will commonly suffer almost crippling bouts of pain associated with quick movements, or movements where the are is moved into, or towards limitations of range.
The movement restriction is in what is referred to as a capsular pattern, with range of movement loss first impacting external rotation of the shoulder, abduction and hand behind back positions, with elevation (flexion) positions generally being the last of the movements to be restricted. A subjective diagnostic feature is significant night pain, noted that substantial sleep disturbance with shoulder conditions is something that is not exclusive to a frozen shoulder, however is present with most individuals suffering the condition and may alert you to the possibility of a frozen shoulder as a potential diagnosis.
Who Is At Risk Of Getting The Condition?
It is suggested that frozen shoulders impact up to 5% of the population, and that there is a genetic link, meaning if one of your parents has had a frozen shoulder then you are more likely to suffer the condition in the future yourself. It is known to affect women more than men and more common in diabetics, or those with thyroid issues. As previously mentioned the condition presents most commonly in the 5th–6th decades and can affect either arm, but slightly more common in the non-dominant arm. Rarely, but in some circumstances individuals my experience the condition on both sides of their body at the same time, or suffer a frozen shoulder on the same side multiple times but as mentioned this is uncommon.
As mentioned the exact cause is uncertain, but has been shown to be more prevalent in:
- People with thyroid disorders
- Parkinson disease
- Post traumatic incidents involving the upper limb
- Post operative recovery following surgery to the upper limb or breast
Because high level of involvement with obesity, diabetics and individuals with thyroid disorders some consider a frozen shoulder may actual be a metabolic disorder, a sort of autoimmune disease.
The Stages Of A Frozen Shoulder
A frozen shoulder is commonly described in text and to patients as having three phases, as listed below:
- The “freezing phase” this typically lasts anywhere from 2-9 months, it is this phase where sleep will be disturbed and when the individual suffers significant discomfort as the condition and stiffness develops.
- The “frozen phase” will last somewhere around 4-12 months, as a rule this phase will not be as painful as the initial “freezing phase” and will often only be uncomfortable if the shoulder is stretched beyond its limitations. Stiffness is significant yet the previously described disabling sharp pains and background constant discomfort has typically subsided and pain is only experienced on stretching the shoulder into movements at the end of range.
- The “thawing phase” may take anywhere from 5-24 months, in this stage the range of movement begins to restore and varied amounts of freedom of movement and symptom resolution occurs, ultimately the end result is very much individual dependent.
Generally a frozen shoulder is considered to take somewhere between 1-2 years to resolve and go through the above three stages of variable lengths. It is what is referred to as a self limiting condition, meaning it will generally “run its course” and mostly settle if given enough time to do so. It is suggested in some studies that around 40% of people will be left with a permanent mild loss of motion and symptoms following the onset of “50 year old shoulder” and around 10% with have more significant long term restrictions of movement at the shoulder joint. The impact of any limitations on an individuals life are, well exactly that “individual”. Clearly a 50 year old who has a frozen shoulder in their dominant arm and plays regular recreational tennis who is left with a residual restriction of range of movement following the condition running its course will find serving, smashing and some ground stroke function impacted. For this person they will consider any residual limitations to negatively impact their quality of life, so would potentially report a poor outcome. Yet, the similarly aged individual who doesn’t play any sport, or require full elevation for their occupation, or hobbies may report no such limitations despite having the some range of movement loss once the process has runs its course.
Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on What Is A Frozen Shoulder? should consult his or her general practitioner, physiotherapist or otherwise appropriately skilled practitioner.