There’s nothing like a picture to tell a story. At Northern Edge Physical Therapy, we utilize ultrasound imaging to allow us to get a realistic snapshot into tissue dysfunction. The shoulder complex is the most common region we implement such technology. Through ultrasound imaging we are able to investigate the rotator cuff musculature, bony contours, and joint capsule to determine the cause of your pain. Imaging is a crucial piece of differential diagnosis for frozen shoulder as the symptom presentation is often challenging. A clear diagnosis allows us to design a plan that caters to tissue dysfunction. Keeping a course helps us get you back to the things you want to do.
My father-in-law started to develop pain and limited motion in his right shoulder which began to affect his ability to work as an airline pilot. Obviously concerned about the increasing pain and stiffness, he sought treatment from chiropractors, a general practitioner, and massage therapists. Instead of progressing with shoulder range of motion and strength, he seemed to be losing more and more motion. This trend continued and he was finally diagnosed with frozen shoulder. His story is not unique, as frozen shoulder is commonly misdiagnosed. Numerous shoulder conditions can mimic frozen shoulder and lead patients down a frustrating path of random treatment plans.
So what is true frozen shoulder? The medical term for frozen shoulder is adhesive capsulitis which essentially means stiffening of the ligaments surrounding the shoulder joint. It affects approximately 3% of the population and unfortunately, it is idiopathic (cause unknown). The shoulder is the only joint known to go through a “freezing” phase. It remains a medical mystery to this day. Although the cause is unknown, there are some factors that predispose an individual to experience adhesive capsulitis:
- Women between the ages of 40-70
- History of diabetes mellitus
- Recent surgery or operation on the affected shoulder
- Recent injury to the shoulder
- Prolonged immobilization (i.e wearing a brace or sling too long)
Despite the unknown nature of frozen shoulder, physical therapy remains the best approach to achieving full function of the glenohumeral joint. Physical therapists are trained to identify impairments (limitations in function) and design tailored treatment to address specific limitations. Through a thorough physical examination, a skilled PT will assess range of motion, strength, joint end-feel, and function. From there, your physical therapist will perform manual therapy to aid in decreasing muscle tone and improve joint motion. Next, they will prescribe specific exercises to improve glenohumeral and scapular stability and well as stretch the joint capsule.
How to Tell If You Have True Frozen Shoulder
There are many shoulder conditions that can be mistaken for frozen shoulder. These may include irritation of the suprascapular nerve, labral tear, osteoarthritis, shoulder impingement, or rotator cuff tear. The good news is that adhesive capsulitis has a distinct capsular pattern.
ER (external rotation) limitations > ABD (abduction) limitations > IR (internal rotation) limitations. This means that reaching for your seat-belt will be most difficult, followed by putting on your belt, followed by washing your hair. Capsular patterns are treated by restoring arthrokinematics (joint mechanics) of the shoulder. The shoulder is a ball and socket joint. By nature, a ball and socket joint must be able to roll and glide in opposite directions in order to move the upper extremity. Without proper roll and gliding of the ball in the socket, the shoulder will experience pain and limited mobility. To restore proper arthrokinematics, the shoulder joint NEEDS to be mobilized and NOT stretched. Stretching addresses only muscle and tendon shortening, but mobilization covers ligaments and the joint capsule tissue which becomes fibrotic with adhesive capsulitis. With frozen shoulder we want to address the stiffness in the joint capsule by aggressively mobilizing the stiffness.
What We Offer That is Different
If your shoulder pain is puzzling to doctors and you do not seem to get a clear diagnosis, we may be able to help. Research demonstrates that ultrasound imaging is one of the most effective means to diagnose adhesive capsulitis. At Northern Edge Physical Therapy we offer ultrasound imaging combined with orthopedic tests to determine the cause of shoulder dysfunction.
If it is deemed that adhesive capsulitis is the primary issue, we employ a tailored program to address whichever impairments are identified. One of the key ingredients to rehabilitation of the shoulder is to utilize muscle EMG (electromyography). Muscle EMG will measure muscle activation and project data onto a television to give you instant feedback. This encourages our patients to activate the proper muscles in order to restore a balance around the shoulder joint. Stiffness and pain in the shoulder joint is not a life sentence. Instead, let us guide you on the path to healing.
Dr. Keith Poorbaugh has completed specialty certifications, internships and a residency fellowship to develop mastery of manual therapy skills and clinical expertise. Throughout 20 years of clinical experience, he has discovered that clients consistently heal faster when the provider is both compassionate and skilled.