Internet Engenders Fear On Frozen Shoulder!
Before we talk about how lets talk about fear! After all fear and psychology affect all injuries as we have discussed previously in our Blog. As we mentioned the names Frozen Shoulder and Adhesive Capsulitis hardly fill you full of confidence. Equally Frozen Shoulder is a very easy label to hang onto. “My shoulder doesn’t move as it should, it must be frozen shoulder. I know I’ll Google (or any just as useful search engines – I understand they do exist!) it to see what I should do.” You may even have found this article by doing such a thing.
Then before your very eyes the search page results are awash with all kinds of information. Most of it misleading and or incorrect. Certainly non of it personal to you, your life, or your condition. You also need to consider with you do actually, genuinely, have frozen shoulder? At which point none of the information is relevant to you. Frequently we find Frozen Shoulder over diagnosed for someone who simply doesn’t have full range of movement in their shoulder.
What Actually Is Frozen Shoulder?
In the physiotherapy world it’s actually quite a controversial diagnosis with some claiming it’s not really a condition.
The idea is that it’s a tightening of the joint capsule around the joint. That’s the really stringy bit around the joint that keeps the synovial fluid (think Castrol GTX for joints) in place. This tightening leads to a marked limitation on shoulder movement as the tension is so close to the joint is has a significant effect.
This can occur after a prolonged increase in background low grade inflammation.
Why Would I Get Frozen Shoulder?
It’s quite a lot random. But there are certain groups of the population who are more at risk than your average Joe:
- If you are over 40 – that would be me
- If you are diabetic – got that one nailed too
- If you are overweight – technically I’m ok on that one but the wife might disagree after out trip to Italy!
- If you have high stress levels – defer to the wife again on that one! – stress increase the production of low level background inflammation which is thought to lead to Frozen Shoulder
- If you have had previous injury around the shoulder or elbow – as a swimmer for 35 years done that one too
- If you have cardiovascular disease – dodged the full house, for now at least!
You can see where my interest in this particular injury comes from!
What Mimics Frozen Shoulder?
As mentioned previously I believe it is frequently over diagnosed. In 12 years I’ve seen 2 genuine cases that were shown to be Frozen Shoulder. I’ve seen at least 100 people who have been diagnosed with it incorrectly. It seems that any severe lack of range of movement in the shoulder is immediately pronounced Frozen Shoulder. Possibly because the name fits. If the shoulder doesn’t move, it must be frozen.
More consistently we see problems with rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis for those that are interested). These are the small muscles around the shoulder joint are involved in the small intrinsic movements of the shoulder joint to allow it full mobility. If they are not working, in varying degrees of dysfunction, it will limit the shoulder range a bit or quite significantly.
Equally the nerve which makes all the muscles around the shoulder work can be affected – usually by bio-mechanics elsewhere – and this limits the movement of the shoulder. There can also be myofascial (muscles and connective tissue) limitations elsewhere which don’t allow to shoulder to fully “express” itself in terms of movement.
All of the above, or more realistically a combination of all three, will mimic the symptoms of Frozen Shoulder and potentially instil further fear and pain avoidance movement patterns.
How Do I Know If I Have Frozen Shoulder?
Honestly I’d say the best thing to do would be to come and see us and if we can’t fix it it’s most likely to be Frozen Shoulder. There are of course other shoulder conditions that need to be ruled out or ruled in – if it was that simple we’d be bored! – but each has it’s own subtleties that in 90% of cases can be worked out and corrected.
You’d think MRI might be useful. But in this interesting piece of research here it would appear that even after an MRI the chances of diagnosing it correctly are only 50%. Perversely, you may have a thickening of the joint capsule but that may not be what is causing the limitation in movement!
What Should I Do?
Well the good news is it normally spontaneously sorts itself out in 1 to 2 years! If you haven’t got that long to wait, you might want a plan B.
If you are in any doubt over whether you have Frozen Shoulder or not you should contact your favourite Sports Therapist or Physio so that they can fully assess and work out if you do genuinely have the condition. This will ease the worry and / or aggravation of wondering what it is or isn’t and what you and your therapist can do about it together. If you do nothing fear of using the shoulder will then lead to a decrease in usage which leads to loss of range of movement and the condition worsens.
If we’re unable to help you then the surgeon’s knife is the final option. Happily this is increasingly effective in such conditions. So long as all other possible causes of the lack of range in the shoulder have been ruled out. The recovery from such an arthroscopic operation is usually fairly swift. Once done the remaining rehab is quite straight forward.
So if you peer beyond the jargon to what we truly “know” then something that sounds incredibly scary and debilitating can very often be easily fixed. It’s such a shame that with the advent of the internet physio and doctor that these conditions often get blown up out of all proportion. Remember a little knowledge is a dangerous thing!
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This article first appeared on our Brighton site.