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Medical Advice

The Big Chill: Frozen Shoulder

Recovering from a shoulder injury can be the least of your problems.

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Cut-away moves are notoriously hard on shoulders, and can lead to a number of injuries that if not properly cared for can result in a painful and long-lasting condition known as “frozen shoulder.” Patrick McGuigan sticks the dyno on All the Way (V7), Happy Valley, Massachusetts. Photo: Brian Lewis.

Sometimes it’s good to curse for emotional release. Like when you come off the last move of your three-year project because you tripped on a shoelace. The Greeks call it lelochezia. Not sure if that’s a verb or a noun, but you get the idea. So, on behalf of all climbers who have had the displeasure of a frozen shoulder, let me articulate a common sentiment—C*#$! Ass!~!

Right. Now I think you have a clear picture of what a frozen shoulder is like relative to other ailments. Adhesive capsulitis, or frozen shoulder, is when the capsule (or curtain) that surrounds and supports the shoulder joint becomes inflamed (the freezing phase), stays that way for a year or two (frozen phase), and then recovers to be fairly normal again (thawing phase).

The shoulder capsule is moderately lax to give the joint an immense range of motion. When tissue is inflamed it becomes sticky. Like a strip of duct tape, the capsule tends to adhere when it folds and touches itself. As the adhesions migrate along the capsular surface a little at a time, shoulder range of motion is progressively restricted.

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The first phase, inflammation of the capsule that surrounds the shoulder joint, is kicked off by a notable event, such as a minor shoulder injury—causes are widely varied and often indeterminate. Freezing can also take place while the shoulder is forcibly immobilized—say, post-surgery or due to a fracture. People with certain conditions, like diabetes or a thyroid problem, have a proclivity for adhesive capsulitis.

A frozen shoulder typically begins when movement becomes painful and is progressively compromised. Once the shoulder is frozen, although it may be relatively pain free (if you keep it by your side), you can expect something between a mildly limited range to, “OMG, I’m one-armed.” Here’s the hitch—the immobilization can last a couple of years!

Then comes the thawing, a drawn-out stage in which your shoulder can take up to a year to get back to reasonable function.

Diagnosis can be tricky early on given that there is often a background of other shoulder issues that likely instigated the condition. Minor tendon tears, cartilage lesions or simply some joint degeneration can disguise the more sinister adhesive process. Most people don’t notice until the shoulder is well into the freezing phase. The people who notice early on are usually already seeing a physical therapist for the sore shoulder.

The hallmark feature that differentiates adhesive capsulitis from other shoulder ailments is that the patient is physically unable to lift an arm—it feels stuck in position. The physician can also not lift the arm, even when the shoulder is relaxed.

If the arm can be lifted, either by the patient or therapist, no matter the level of discomfort, then the shoulder is not frozen (yet!), and something else is at play.

Thawing a Frozen Shoulder

When a condition is this much of a conundrum there is almost always a whole array of mainstream and “alternative” treatment options. That so many remedies are offered does not mean many are effective.

Rule one: All electrical gizmos, used either by a therapist or sold to you for the purpose of your shoulder pain, constitute nothing more than theft.

Rule two: If the remedy is something you rub on, refer to rule number one.

Rule three: Any treatment that has been shown to be effective is excruciating at some point, hence my earlier description of curses.

Most people—90 percent—will get back to normal in two to three years if they skip medical intervention. If you are invested in your rock-climber identity, doing nothing is not the best plan.

Treatment depends on what phase you are in at the time of diagnosis, and what other ailments are in the background. If the syndrome is caught early in the freezing phase, a cortisone injection  followed by intense physical therapy can halt the inflammation and break the capsular adhesions.

If there are major background issues, such as an unstable cartilage tear, then it is likely that surgery is the first (and second!) line of treatment.

A shoulder that is completely frozen is a concern. Physical therapy alone will succeed, but can take a year or so, and becomes an issue of finances and pain resilience, versus a more protracted but similar outcome from doing nothing. A small percentage of frozen shoulders will not loosen by themselves and require surgery followed by physical therapy. Surgery is primarily about breaking the adhesions to improve range of motion and addressing any issues such as tendon or cartilage tears that may have been the root of the problem.

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Surgery alone will not resolve frozen shoulder. Rather, it acts as a kick-start, placing you back at the beginning of the pathological process when you had minimal adhesions. This affords you another rehab opportunity without which your shoulder will simply re-freeze.

In terms of exercise, pandering to your shoulder is a dead end. The only barrier between you and full range is your pain tolerance. I am not diminishing pain as a legitimate barrier, but in this instance you are simply fighting against a runaway physiological malfunction. Use what range you have on a daily basis and ask for more. I don’t care if you’re rock climbing or swinging from the chandelier—your shoulder needs to be pushed or it will not improve until it has run its long course.

Start by crawling your hand up a wall. Treat it like a climbing project—go for a high point every day. Add in daily tasks that you cannot achieve, be it opening a cupboard above your head or riding your chopper with angel bars.

This article appeared in Rock and Ice issue 258 (July 2019).

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