Why Frozen Shoulder May Develop?
Hormonal - In the case of female patients, Frozen Shoulder occurs more commonly at about the same time as the menopause.
Genetic - Several studies have indicated that there is a genetic component for developing a Frozen Shoulder. For example, there have been cases where identical twins have suffered at the exact same time. It is also a condition that can run in the family.
Autoimmune - There is a theory that the body mounts a rejection type reaction to damaged shoulder tendons, perceiving them to be foreign material. This may also explain why Frozen Shoulder does not return on the same side.
Postural - The most convincing study results yet have indicated that long-standing round-shouldered posture causes a shortening in one of the shoulder ligaments. This chronic ligamentous shortening seems to be very closely associated with the Frozen Shoulder.
Frozen Shoulder and Diabetes
Frozen shoulder is much more common in diabetics; about 10-20% are affected (compared to 2-5% of the general population). It is not clear why this should be the case but experimental studies have shown that the soft tissues of the shoulder are stiffer than normal. All muscle fibres are ‘packed’ within other tissue called parenchyma. This packing substance is made of collagen. Collagen helps to make up the elastic component of the skin and muscles (as we get older our skin wrinkles as a result of decreased collagen production). US doctors NA Friedman and MM LaBan published a paper in 1989 in which they put forward two theories as to why frozen shoulder is more common in those suffering with diabetes.
Diabetes and Frozen Shoulder - Theory 1
Because type I diabetics are unable to regulate their blood sugar levels naturally, there are many times during the day that the sugar levels may be high, which can lead to an accumulation of sugar-alcohol in the tissues. This sugar-alcohol is called sorbitol and it accumulates in the ‘ground substance’ of the connective tissues (collagen) where, because it has a higher osmotic pressure, it attracts water, making the tissues stiffer.
Diabetes and Frozen Shoulder - Theory 2
An alternative explanation has been put forward, whereby the properties of the collagen itself are attenuated. It has been suggested that the collagen becomes embedded with excess sugar called glycogen. This ‘glycosylation’ of collagen leads to more bonds and bridges being formed at a molecular level between collagen molecules, thus changing the internal structure of the collagen. This means that enzymes cannot efficiently replace normal collagen wear and tear, and the tissues get stiffer.
It’s a fact that more women are afflicted with frozen shoulder than men - and the majority of these women will contract frozen shoulder when they are undergoing menopause.
Here are some useful tips to help avoid “menopausal shoulder”:
- We know it’s a cliche - but regular exercise could help you avoid a frozen shoulder. Find an exercise regime that works for you and which includes exercises specifically related to your shoulders. Long term lack of mobility is one of the major suspected causes of frozen shoulder syndrome. You can download our free shoulder exercise guide or visit our shoulder exercise section for more information.
- Always remember to stretch before exercise. You need to be sure that your body is warmed-up so that your shoulders can move more freely and easily. Visit our shoulder exercise page for more information.
- Where possible, avoid strenuous activity of the shoulders during the time of the month. This is the time when your hormones are acting to loosen ligaments and thus make you more prone to injury.
- It’s another cliche - but you’d be well advised to watch what you eat, especially as your diet relates directly to bone density and general health. Be sure to include plenty of fresh fruit and vegetables. Stick to low-fat milk and dairy products made with low fat milk; and try to limit the amount of red meat that you eat to a healthy minimum.
If you are currently suffering from a “menopausal” frozen shoulder, you should follow the general advice within this website. In particular, we recommend that you read the information regarding common treatments.
Frozen Shoulder affects 3-5% of the
general population - this increases to
10-20% for people with Diabetes
By Simeon Niel-Asher BSc Ost BPhill NAT
With a frozen shoulder, the shoulder capsule thickens and becomes tight. Stiff bands of tissue (referred to as adhesions) develop. In many cases, there is less synovial fluid in the joint.
The hallmark sign of a “frozen shoulder” is being unable to move your shoulder - either on your own or with the help of someone else.
According to the American Academy of Orthopaedic Surgeons - “More than 90% of patients improve with relatively simple treatments to control pain and restore motion”.
What is Frozen Shoulder? (Adhesive Capsulitis)
Frozen Shoulder Syndrome (FSS) is a common and debilitating condition. It is a clinical diagnosis and is only very rarely the result of an underlying illness or pathology. FSS is
common, affecting 2-5% of the population. One of the many enigmas is that, once cured it (almost) never comes back again.
The condition is often misdiagnosed so we like to keep things simple and define it as a "a stiff shoulder with less than 50% of normal range of active and passive motion in any direction".
The important point here is that you can’t lift the shoulder and neither can anyone else lift it for you – it is completely stiff and locked. Other conditions can cause the shoulder to stiffen but typically, only in certain directions of movement.
Over the past 15 years we have have treated literally thousands of FSS patients from all over the world. We know what you are going through; the pain, the sleepless nights, the stiffness, the inability to do even the simplest tasks. Worst of all, you look “normal” to the world outside and yet you are suffering within. The good news is that it will get better and there are things you can do to speed it up.
In a Frozen Shoulder Syndrome the lax capsular sack becomes sticky and can sometimes (though not always) form adhesions; hence the name of the condition. The stickiness is brought on through inflammation; research has pinpointed the source of this is in the rotator interval. This inflammation often starts in the groove behind the biceps tendon. This can occur after a small injury or can even be brought about by something simple like reaching for the back seat of the car. Once established this inflammation spreads into other shoulder soft-tissues and can cause swelling in other shoulder sacks (bursae). This happens because the muscles, ligaments and bursae within the shoulder are very much interconnected.
The stiffness is due to an 'over-reaction' of the body to the inflammation (within the rotator interval/biceps groove). The body then seems to 'switch off' muscles in a co-ordinated sequence; this sequence is the same for everyone and we call it the 'capsular pattern'. Often in less than a week, the arm movements start to diminish, and within a few weeks the arm literally becomes “frozen” and for many, cannot be raised more than 40° in any direction. The muscles of the rotator cuff then become weak and start slowly to waste away, leaving the arm to hang stiff and immobile.
Causes of Frozen Shoulder
Despite the fact that Dr Duplay first described the syndrome in the late 19th Century, the causes of frozen shoulder (or Adhesive Capsulitis) are poorly understood.
FSS often appears for no apparent reason (primary) but can stem from an injury to the shoulder (secondary). In our experience it tends to start with a 'tweak' in the shoulder that doesn't seem to resolve. This 'tweak' seems to occur in the region of the long head of the biceps - it is the cause of a horrible sharp “catching” pain that FSS sufferers will be familiar with.
Frozen Shoulder can last up to 30 months if left untreated, but the overwhelming majority of cases can be effectively treated with conservative (hands-on) treatment.
The absolute best thing to do if you feel you have a frozen shoulder is to seek advice from a therapist or practitioner skilled in assessing and treating the condition. The shoulder is a highly complex part of the body (and by far the most mobile) and it is often difficult, even for medical practitioners, to make an accurate early assessment of a shoulder injury.
If you have already been diagnosed with frozen shoulder, you can search this site for a practitioner near you who may provide conservative (hands-on) treatment.
If you have not yet been diagnosed, you may like to try the free symptom test on this site which might provide an initial guide. Again, you can then search for a practitioner who can provide you with an early assessment of your condition and advise on a course of treatment.
Frozen shoulder can also be treated very effectively in your own home. We offer a home-healing program which consists of a fully-illustrated book and DVD designed to guide you through the step-by-step process of treating your shoulder. The online version of the home-healing program is available on this site and you can try it for free for 30 days.
Risk Factors for Frozen Shoulder
Ageing - In Japan frozen shoulder syndrome is called "Fifties Shoulder".
Posture - especially round-shouldered
Shoulder intensive or repetitive manual occupation
Diabetes - Types I and II
Immobilization / splinting
Fracture of the collar bone or humerus (arm bone)
Surgery (especially after shoulder surgery, or mastectomy with breast reconstruction)
Frozen Shoulder Fact File
More common in women (60%)
At least five times more common in diabetics
Slightly more common in patients with Dupytren's contracture and shares some of the same pathology
May have a genetic component i.e. it can run in the family
Seems to affect 40-70 year olds
About 15% of people develop frozen shoulder on both sides (commonly within 6-12 months of the first occurrence)
Can occur after shoulder surgery
Can occur after breast reconstruction surgery
It can, rarely, be a precursor for other pathologies
How long does Frozen Shoulder Last?
We generally observe four distinct phases which - without treatment - will endure over an average period of 30 months. In most cases, treatment with the Niel-Asher Technique will speed up recovery by about 10 times.
|Without Treatment||Niel-Asher Technique™|
|Pre-Freezing (0-4 weeks)||1-5 Sessions|
|Freezing (1-8 months)||7-13 Sessions|
|Frozen (9-16 months)||5-8 Sessions|
|Thawing (12-40 months)||4-7 Sessions|