Frozen Shoulder Symptoms

Lets talk about frozen shoulder symptoms.

Before we can get into frozen shoulder symptoms, lets start with the anatomy of the shoulder.

Another article that might help you is What is Frozen Shoulder?

Frozen Shoulder Anatomy

In 1934, Codman described frozen shoulder syndrome as a musculoskeletal condition that is difficult and complex to define, treat, and explain. The statement is still applicable today, despite the increased research of frozen shoulder.

The exact cause of frozen shoulder is yet to be completely understood, but researchers have suggested a number of probable contributing factors to the disease. In order to better understand the cause of frozen shoulder, it is essential to learn more about the shoulder is made up, by gaining a better understanding about the shoulder anatomy.

Joints of the Shoulder

The human shoulder mainly consists of three bones:

  1. the collarbone (clavicle)
  2. the shoulder blade (scapula)
  3. the upper arm (humerus)

Other things that make up the shoulder joint are tendons, ligaments, and certain muscles that provide stability to the shoulder.

The shoulder joint consists of four joints or articulations:

  1. glenohumeral joint
  2. acromioclavicular joint
  3. sternoclavicular joint
  4. scapulathoracic joint

The glenohumeral joint, considered the major shoulder joint, is commonly referred to as the shoulder joint. This particular joint is the one involved in frozen shoulder (adhesive capsulitis).

The True Shoulder Joint: The Joint that Frozen Shoulder Targets

The glenohumeral joint is classified as a modified ball-and-socket joint. Ball-and-socket joints are multi-axial joints that have the ability to move in all axes, including rotation.

A ball-and-socket joint is the most freely moving of joints. However, having the ability to move in a wide degree of has a downside. Although the glenohumeral joint has the ability to move through a full 360 degrees of rotation, it can be exceedingly susceptible to dislocations, instabilities, and injuries. These shoulder injuries may all lead to shoulder pain, which may then lead to frozen shoulder.

The spherical head of the humerus or upper arm bone fits into the shallow socket in the shoulder blade. This socket is called the glenoid fossa. The head of the humerus is connected to the dish-shaped glenoid fossa by poorly reinforced ligaments. The shallowness of the glenoid fossa and the loose connections between the shoulder and the upper arm allow the glenohumeral joint to have a wide degree of flexibility.

There is a disproportion between the head of the humerus and the glenoid fossa. Only one-third to one-half of the humeral head is in contact with the fossa. To support the larger humeral head, a ring of fibrous cartilage, called the glenoid labrum, encircles the glenoid cavity to deepen the socket. Deepening of the socket provides static stability to the glenohumeral joint.

The Joint Capsule – What is Affected in Frozen Shoulder

Surrounding the glenohumeral joint is a capsule, an elastic soft tissue that attaches to the shoulder blade, the humerus, and to the head of the biceps muscles. When the arm is raised above the head, the capsule is completely stretched. When the arm is lowered to the side, the capsule sags.

Although the joint capsule completely covers the glenohumeral joint, it is exceptionally loose. The looseness and elasticity of the joint capsule is one of the factors that allows the shoulder’s enormous range of motion. The capsule is strengthened by glenohumeral ligaments and semicircular humeri ligament.

Within the joint capsule is a joint cavity, which is lined by the synovial membrane. The synovial membrane produces the synovial fluid, which lubricates and nourishes the joints.

A person with a frozen shoulder syndrome would usually have an inflamed, thickened, or contracted joint capsule. In most cases, the supporting ligaments demonstrate the same changes. As a result, the normal looseness and elasticity of the capsule is lost, leading to stiffness and pain.

Frozen Shoulder Symptoms

 Frozen shoulder syndrome is characterized by shoulder pain, stiffness, and restricted range of motion of the affected shoulder. As noted by Codman in the 1930s, patients with frozen shoulder typically display significant decrease in forward elevation (flexion) and external rotation of the shoulder during examination. These signs are generally accepted as the hallmarks of frozen shoulder (Dias, Cutts, & Massoud, 2005).

The signs and symptoms of frozen shoulder have three phases:

  1. the freezing phase
  2. the frozen or adhesive phase
  3. the thawing or recovery

First Phase of Frozen Shoulder: The freezing or painful phase

The first symptom of frozen shoulder is the insidious onset of shoulder pain, which is usually worse at night. The aching pain frequently occurs in the absence of a precipitating factor. The pain becomes more severe when one lies on the affected side; however, the pain is not related to activity. The pain spreads and progresses. It is during this phase where patients complain of shoulder pain at rest.

The freezing phase lasts between 2 and 9 months. The range of motion is not restricted, but the pain may be aggravated when the shoulder is moved to its farthest range of motion. Diagnosis is not usually made during the first phase.

Second phase: The frozen or adhesive phase

The pain occurring in the first phase may persist, although it may decrease in certain cases. The frozen phase is characterized by stiffness and limitation in shoulder motion in all directions. Inability to move the affected shoulder is more than enough to disrupt one’s normal daily activities, such as combing the hair, reaching for the back pocket, preparing food, scratching the back, and carrying a bag.

The most severely affected shoulder motion is the rotation of the arm outwards. Because of the pain and stiffness, a person with frozen shoulder may significantly limit his or her movements. Immobilization and disuse may lead to wasting of the muscles surrounding the shoulder.

The second phase usually lasts between 3 and 9 months, though the signs and symptoms may last longer in some patients. Diagnosis can be made during this phase.

Third phase: The thawing or regressive phase

The third phase is characterized by progressive decrease in shoulder pain. The pain is usually only felt when the shoulder is moved at its end of range of motion.

In spite of the decreasing pain, progressive limitation in the shoulder’s range of motion persists. The restriction of shoulder movement may progress for the next 12 to 24 months. Certain patients may be in this phase for as long as 4 years.

After a period of time, the stiffness eventually diminishes and shoulder movement gradually returns to normal or near normal. It was found about 40% of patients with frozen shoulder may have mild limitations in range of motion. About 10% of those with frozen shoulder may have significant and long-lasting limitations involving the affected shoulder.

The severity and duration of symptoms may vary from person to person. About 90% of patients with frozen shoulder experience pain for 1 to 2 years before subsiding.

I hope this helped you when it comes to better understanding your frozen shoulder symptoms.

Rick Kaselj, MS