It’s a painful and limiting condition that can take up to three years to heal if left untreated. So what can you do? Margaret Jennings finds out.
YOU might wince with pain stretching to get your ticket out of the car park machine, or find that reaching for something in the kitchen cupboard, for instance, causes equal discomfort.
If so, welcome to the world of the ‘frozen shoulder’ syndrome – a painful and limiting condition that can last between one and three years, if it’s left untreated.
The Chinese call it the ‘50-year-old shoulder’ and they are not being ageist; up to 3-5% of our population will suffer from the condition and the majority are between 49 and 62, according to Eoin O’Conaire, a chartered physiotherapist at Evidence-Base Therapy Centre (EBTC) in Galway.
“It’s very common and it’s a very painful, pretty miserable condition. In my experience people often go quite a while before they are diagnosed, so sometimes by the time they have come to me they have seen other people, or the GP, and it hasn’t been picked up,” says Eoin, who specialises in the condition.
“Typically someone will come to me and say that they noticed a little bit of pain when they were reaching upwards or outwards, or reaching backwards when driving the car — and then for no apparent reason the pain continues to get worse. And, usually, they will start waking up in the middle of the night with pain — to the point that any movements of above 90 degrees or above shoulder height, cause a problem.”
It’s a spectrum condition, so people can experience a varying intensity of pain and length of time for it to resolve.
“I always say to my patients when diagnosing them, that the good news is, it almost always get better; the bad news is that it can take a very long time,” says the physiotherapist. “The biggest research study shows that the average length of time from start to finish of frozen shoulder, is 30 months.”
While it is still a bit of a mystery why it hits that particular demographic, it is generally believed there is a link between a slowing down of our metabolism and also hormonal changes, at that age.
“The three main risk factors we have identified are being in your 50s, having diabetes and having a thyroid problem,” says Eoin. “We know the main cause is a structure deep in the shoulder called the joint capsule, which is a loose soft tissue sleeve that wraps around the ball and socket joint. In frozen shoulder, this becomes raw and irritated and then contracts or shrinks.”
The raw and irritated capsule causes the pain and then the contraction and shrinkage of the capsule blocks the movement: the two hallmarks of frozen shoulder
“What we do know is that lots of different cells that aren’t usually found in the capsule enter it and this then changes the texture of the capsule, but what we don’t know for sure is why this happens,” he says.
“One clue is that while that 3-5% of the general population in that age group get a frozen shoulder, about 20-30% of diabetics will get it. Taking that, with the profile also being generally in their 50s, we figure there must be a link between metabolism and frozen shoulder so it’s more got to do with the general system, than a specific injury.”
While talking to his patients about the specifics of treating their pain and loss of movement takes precedence, Eoin will also then have a conversation about it being perhaps an “alarm bell” to
look at general exercise and diet and lifestyle factors.
If someone comes with bi-lateral frozen shoulder — the condition on both sides, he always sends them back to the GP to have a glucose tolerance test, because often they are diabetic or pre-diabetic.
While there is no data as yet, he says practitioners have seen an increase in frozen shoulder, as the incidence of type 2 diabetes rises in Ireland.
There is also controversy around the suggestion that women are more prone and whether this is a link between hormonal changes taking place in their 50s and those changes in the shoulder capsule.
The jury is out on this, as there isn’t research to support it, says Eoin. However, having treated over 2,000 people with frozen shoulder so far, in his career, he says about 70% are female.
“I think that’s because they tend to seek help more frequently and earlier for their health problems, but the research is unclear on whether there is a higher incidence in women,” he says.
In the meantime, lots of research is being done in the “shoulder world” on whether lifestyle — diet and exercise — can be a preventable factor.
“Sometimes people think that they are at fault, that they didn’t use their shoulder enough, and that’s not technically the case,” he says. “But an increase in sedentary lifestyle, reduced exercise and poor diet and metabolism issues are almost certainly linked to frozen shoulder,” he adds.
Since a healthy lifestyle is so important for us to adapt, in order to maintain fitness as we age, perhaps potentially reducing our risk of getting frozen shoulder, is another good reason to keep it high on our agenda.
- For information on treatment options see: www.ebtc.ie