Months tend to pass before the stoic frozen shoulder sufferer finally seeks medical advice. By this time, shoulder function is usually moderately impaired and pain symptoms are constant. Common complaints include the inability to don a jacket, retrieve a wallet from the back pocket, or snap one’s brassiere. Sleeping while on the side of the involved shoulder is also poorly tolerated and may enhance the problem.
When questioned about the origins, one may recall previous activity requiring repeated use of the shoulder such as painting, washing windows, golfing or even getting an injection in the arm. An aggressive lifting activity or fall may have followed this incident where the arm was extended to dampen the impact. The possible scenarios are endless and commonly perceived as innocuous, thus adding to the frustration in the early diagnostic process.
The Term “Frozen Shoulder”
Though probably in existence since man attempted to reach overhead for an apple, the term frozen shoulder was coined only recently by the well-known Boston orthopedist EA Codman in 1934. As with many perplexing pathologies of the day, the condition was identified in a less than scientific fashion. Unfortunately, there has been a relative standstill over the past 66 years in regard to solving this puzzle thereby providing a viable treatment option for the thousands of unsuspecting victims (predominately females age 50 to 70) who are overcome by this troubling and disabling battle year after year.
Codman noted that “Even the most protracted cases recover with or without treatment in about two years”. This statement has unfortunately led to a very passive approach in regard to current treatment rationale, leading to further confusion on the part of both patient and physician, as well as the prolonged period of dysfunction and pain for the sufferer. To further delve into Codman’s findings, his perception of “recovery” referred to the fact that the joint was not left deformed or otherwise damaged, ie. no arthritic change.
This better coincides with the findings of DePalma in 1952, Simmonds in 1949 and Shaffer in 1992, who note that full recovery of the joint is less than guaranteed. In the Shaffer study, a 7 year follow up notes that 50% of the studied population had either pain or stiffness and 60% demonstrated motion loss. It is documented that 12 percent of individuals who are symptomatic with one shoulder are predisposed to a similar problem with the other. It is rare that the same shoulder becomes involved more than once.
If one were to take a look at the actual ongoings in the joint, the predominate finding is scar tissue of varied progression and density located in the connective tissues about the anterior and superior aspect of the shoulder joint. The scarring tends to shorten the tissues and subsequently limit mobility. There is normally a small pouch in the connective tissues about the inferior aspect of the joint; this will also tighten, further reducing joint volume by up to 80%. The diminished mobility will affect the mechanical function of the joint, creating a process of impingement where adjacent joint surfaces impact one another instead of gliding by.