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FROZEN SHOULDER Adhesive capsulitis, or traumatic arthritis of the shoulder, can be an extremely painful and debilitating condition. Traumatic arthritis is one of the many forms of arthritis (joint inflammation), and is the body's way of protecting a joint after it has been injured. Within the shoulder joint, that inflammation typically causes pain, swelling, stiffness, and limitation of movement— symptoms that inspired the common nickname for this condition: frozen shoulder. The shoulder is a ball-and-socket joint that moves in more directions than any other joint in the body, making it particularly vulnerable to irritation and injury. (The more mobility there is in a joint, the more likely injury is to occur.) The ball of the shoulder is the humerus, and the socket is the glenoid fossa, a very shallow depression. The humerus is held in place by a series of ligaments, plus the four rotator cuff tendons; because the joint is so mobile and the joint depression is so shallow, these tendons are needed to add stability. Within the shoulder Shoulder Joint Capsule. Sobotta: Atlas der Anatomie des Menschen @Elsevier GmbH, Urban & Fischer Verlag Munich. joint are thousands of tough fibers (Image 1). When the shoulder has been traumatized in some way, many of these fibers shrink and develop adhesive scar tissue, making any movement that stretches them extremely painful. Adhesive capsulitis is more common in women than in men, occurring with the greatest frequency in women between the ages of 40 and 50. Although there are a number of theories about why it occurs, there are no definitive answers. Some people wake up with this painful injury, while in others it occurs after falling on the shoulder, bumping into something, or even working in the garden. Most people can't recall any specific incident that set off the pain. The symptoms of this condition can last for many months, or even years. Here is a typical progression: • The person feels odd sensations in the upper arm and shoulder, and movement in certain directions gets difficult. • A dull, aching pain develops around the shoulder and/or arm. This pain gets progressively more intense and spreads throughout the entire shoulder region. • Pain begins to travel down the arm, sometimes all the way to the wrist. At this stage, the person may experience sharp pain when reaching forward or have difficulty putting on a coat or a shirt. • Soon the person can't scratch his nose or brush his hair without intense pain. • It becomes impossible to lie on the injured shoulder at night, and may even feel uncomfortable when lying on the good side. Without treatment, adhesive capsulitis typically follows a three-stage cycle of pain. THE THREE STAGES OF PAIN The symptoms of adhesive capsulitis generally last 9–12 months, in three distinct stages. STAGE 1. FREEZING In the beginning, the condition is barely noticeable. Minor pain may be present for a day and then disappear, only to return several days later. Over the course of three to four months, pain continues to increase, while the mobility of the arm decreases. The person begins to experience Boost your practice with ABMP's Website Builder—free for members on ABMP.com 93