Living with a frozen shoulder – a phenomenological inquiry

Abstract

Background Frozen shoulder (adhesive capsulitis) is an inflammatory condition affecting the capsule of the glenohumeral joint. It is characterised by a painful restricted range of passive and active movement in all planes of motion. The impact of frozen shoulder on affected individuals remains poorly characterised. In this study we sought to better understand the lived experience of people suffering from frozen shoulder to characterise the physical, psychological and socioeconomic impact of the condition. Methods A qualitative study using a phenomenological approach was undertaken. Purposeful sampling was used to identify individuals for interview. Semi-structured interviews were performed and continued until saturation was achieved. A biopsychosocial framework was used during the analysis in order to generate themes which best described the phenomenon and reflected the lived experience of individuals’ suffering from this condition. Results Ten interviews were conducted, and five main themes emerged including; the severity of the pain experience, a loss of independence, an altered sense of self, the significant psychological impact, and the variable experience with healthcare providers. Conclusions These findings offer an insight into the lived experience of individuals with frozen shoulder, both on a personal and sociocultural level. The pain endured has profound impacts on physical and mental health, with loss of function resulting in a narrative reconstruction and altered sense of self. Our findings illustrate that frozen shoulder is much more than a benign self-limiting musculoskeletal condition and should be managed accordingly. Trial registration ANZCTR 12620000677909 Registered 28/04/2020 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379719&isReview=true

Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews

“… 1–3 The prevalence of primary FS is estimated to range between 2% and 5% in the general population 4 and between 10% and 38% in patients with diabetes mellitus (with no difference between type 1 diabetes mellitus-DM or type 2 DM) and thyroid diseases which can be considered the main risk factors for secondary FS. 5 , 6 The incidence of FS is higher in patients aged between 40 and 65 years and affects predominantly women and the non-dominant shoulder. 7–9…”

“…[1][2][3] The prevalence of primary FS is estimated to range between 2% and 5% in the general population 4 and between 10% and 38% in patients with diabetes mellitus (with no difference between type 1 diabetes mellitus-DM or type 2 DM) and thyroid diseases which can be considered the main risk factors for secondary FS. 5,6 The incidence of FS is higher in patients aged between 40 and 65 years and affects predominantly women and the non-dominant shoulder. [7][8][9] To date, the pathogenetic mechanisms are still uncertain, but it is accepted that FS is a consequence of inflammation of the synovium that precedes capsular fibrosis just as pain precedes mobility limitations.…”

“…10,11 Patients usually report pain, initially in extreme degrees of ROM, for at least a month and later onset of joint limitation that is predominant in flexion, abduction (at average and extreme degrees) and external rotation (specially between 45 and 90 degrees of abduction) and interferes with activities of daily life. [1][2][3][4][5][6][7][8][9][10] Articular shoulder pain might be provoked by sensitization of structures containing Aδ, Aβ, and C-fibers, proved to be also present in the joint tissue, in the earliest phases. 12 However, with persistent pain and chronic inflammation, pain is associated with hyperexcitability of spinal nociceptive neurons, provoking central sensitization and increasing neurotransmitters release in the joint.…”

The Relationship between Self-Perceived Health and Clinical Symptoms in Patients with Frozen Shoulders

“…Patients with FS have perceived their health status through the activities of daily living, including experiencing shoulder pain and shoulder ROM limitations while performing certain physical activities (e.g., raising hands overhead, combing hair, or washing the back) [ 14 , 15 , 16 ]. Those physical limitations can cause psychological anxiety or depression [ 17 , 18 ], which could reduce their willingness to participate in social activities and could even result in encounters with environmental facilities that are unfavorable to them (e.g., having difficulty pulling the overhead handrail when taking public transportation) [ 14 , 15 ]. Accordingly, FS patients’ perceptions of their health status, as experienced in four dimensions (physical, psychological, social, and environmental interactions), can be expressed in terms of health-related quality of life.…”

“…Evidence has shown that current treatment strategies may be insufficient to satisfy the healthcare needs of patients with FS [ 13 , 15 , 19 , 20 ]. Patients with FS often have different severity of shoulder pain and shoulder ROM limitations, but healthcare professionals often address only those clinical symptoms, ignoring the impacts of the patient’s self-perception of health [ 14 , 15 ]. It is important to be aware of whether the patient’s subjective perception of health is consistent with the measured shoulder pain intensity and shoulder ROM.…”