Chapter 12

Frozen Shoulder Diagnosis

Is my shoulder frozen? How to diagnose adhesive capsulitis and frozen shoulder

It's not hard for an experienced doctor to diagnose frozen shoulder – the story that the patient tells and the findings on examination are very typical and tend to be very consistent from one sufferer to another.

Family doctors can find it difficult because they are not familiar with the patterns of pain and symptoms that occur at the shoulder joint. Diagnosing frozen shoulder is all about recognising the movement limitation pattern that develops.

 

Remember that C5 dermatome

Refresh your memory and take a look back earlier in this book when we spoke about dermatomes and the way that pain spread down embryo segments of our body. Remember that all of the tissues that make up your shoulder come from the same development area of the growing embryo – the fifth segment of the neck. This means that pain from any of these shoulder bits is felt in the same part of the arm – and sometimes all the way to the wrist.

 

What this means in practice is that it's not possible to work out which part of the shoulder is inflamed just by asking someone to describe where their pain is. The pain is always in that C5 segment area – it doesn't matter if it's being caused by frozen shoulder, arthritis, tendonitis or bursitis.

Even the neck gets in on the act sometimes. If the actual nerve from the fifth part of the neck is inflamed or trapped then it too will send pain all the way down that C5 segment of skin.

 

Frozen Shoulder Symptoms – Pain is the problem for most people

There is absolutely no doubt that pain is the cardinal and most important symptom in cases of frozen shoulder. Great numbers of patients have told me that, if it wasn't for the pain, they would be able to get on with their lives even though their shoulder felt stiff or tight.

 

 

Frozen shoulder pain is felt in the C5 dermatome area – and as it becomes more severe it seems to spread all the way down the arm towards the wrist. You can usually tell when recovery is starting because the pain seems to spread back up the arm towards the shoulder – almost as if it was retracing its steps.

 

The nature of frozen shoulder pain is that it follows a pattern of getting worse and worse for several months until a plateau level is reached. The pain often then remains severe at the plateau level for six or nine months before it settles down again and eventually goes away completely. This pattern corresponds to what are called the “freezing up stage” – the “frozen stage” and the “thawing out stage” of the problem.

 

Frozen shoulder pain is typically dull and felt like toothache. Sudden movements of the arm can trigger more severe stabs of pain which can be bad enough to make you feel nauseated, sweaty or even faint at times. These sudden severe pains can shoot all the way down towards the wrist or hand.

The pain is often made worse if you try to move your arm or your hand above your head or if you lie on the affected side at night. This inability to use the arm behind your back can make getting dressed and undressed very difficult and can also cause problems with even basic hygiene after using the toilet.

 

As a general rule, the distance the pain spreads down the arm can be used to judge how irritated the shoulder joint is. Mild inflammation in the capsule causes tolerable pain around the upper arm or shoulder. A badly inflamed capsule will trigger severe, almost unbearable pain, spreading all the way to the wrist.

 

STIFF – STIFF – STIFF

Pain is only one feature of frozen shoulder – major problems with stiffness is the other and these two terrible twins often follow one another hand in hand. In most cases the more painful your shoulder is – the stiffer it will be – and the more problems you'll find if you try to move it or lie on it at night.

The stiffness shows itself most prominently when you try to use the arm above your head or if you try to rotate it around behind your back – and it's this that causes most problems for women trying to dress or undress.

 

Stage One Frozen Shoulder – The Freezing up Stage

The pain and stiffness of a frozen shoulder often just start in a gradual manner. To begin with the pain can be no more than a vague niggle that you might hardly even be aware of. It gradually worsens but there is often very little stiffness to start with and you might not even be aware of anything significantly wrong.

 

This phase is called Stage One Capsulitis – or “the freezing stage” of the condition. It can last anything from two weeks to two months – it's a very individual thing for each sufferer.

 

Pain is the key feature in stage one frozen shoulder. You might be aware of the developing stiffness but it's not usually enough to limit day to day activity or movement. Many sufferers get all the way to the end of stage one without needing to seek help from a doctor or a physical therapist.

 

Stage Two Frozen Shoulder – The Frozen Stage

Stage two of the capsulitis picture arrives as the pain reaches its peak intensity and is more or less constantly present. By now it might well be spreading all the way to the wrist and you will be having significant problems sleeping because of the pain. Day to day function is becoming more and more limited as the stiffness worsens and the pain drags you down.

This is true “frozen shoulder” and is absolutely no fun at all when you are struggling along with it.

This second stage of frozen shoulder can last between six and nine months – longer if you have diabetes.

 

Stage Three Frozen Shoulder – Thawing Out At Last

At last now, we're heading for home. After many months of suffering the pain begins to ease and movement slowly returns to the stiff joint.

This third phase is very variable in its duration.

Most people with frozen shoulder will go from onset to a full recovery in a period of between twelve and eighteen months – but it's the length of the thawing out phase

 

that often is most unpredictable. A few people find that the pain goes fairly quickly but their shoulder continues to feel stiff for many months longer before it finally gets better.

Medical textbooks nearly always quote a period of about eighteen months from start to end of the condition – but I suppose this is best thought of as an average figure. Some people have fully recovered after only about nine months – others take two years or longer – particularly so in diabetic patients. You can read more about what can be done to help diabetic frozen shoulder recover more quickly elsewhere in this book.