Frozen shoulder, medically known as adhesive capsulitis, is a painful and limiting condition affecting the shoulder joint. It is characterised by stiffness, discomfort, and restricted range of motion, often developing gradually and worsening over time. While it can occur in anyone, research suggests that individuals with Parkinson’s disease are more susceptible to developing a frozen shoulder. The link between these two conditions is not always immediately recognised, leading to delayed diagnosis and treatment. Understanding the connection between frozen shoulder and Parkinson’s, as well as exploring effective management strategies, is essential for improving quality of life.

Parkinson’s disease is a progressive neurological disorder that primarily affects movement. It occurs due to the degeneration of dopamine-producing neurons in the brain, leading to symptoms such as tremors, muscle rigidity, bradykinesia (slowness of movement), and postural instability. In addition to these well-known motor symptoms, Parkinson’s can also cause musculoskeletal issues, one of which is a frozen shoulder Parkinson’s. The exact mechanisms linking frozen shoulder and Parkinson’s are not fully understood, but several factors contribute to their association.

One key factor is muscle rigidity, a hallmark of Parkinson’s disease. As the condition progresses, muscles become increasingly stiff, leading to reduced mobility in various joints, including the shoulder. This stiffness can contribute to the onset of a frozen shoulder by limiting normal movement and promoting the development of adhesions within the shoulder joint. Additionally, individuals with Parkinson’s may experience postural abnormalities, such as a stooped posture and forward-leaning head position, which can place excessive strain on the shoulders and contribute to joint dysfunction.

Another contributing factor is bradykinesia, which affects the ability to perform smooth and coordinated movements. Because individuals with Parkinson’s may reduce their overall physical activity due to movement difficulties, their shoulders may become underused, increasing the risk of stiffness and restricted motion. A decrease in spontaneous movement can exacerbate the formation of adhesions within the shoulder capsule, leading to frozen shoulder symptoms.

Pain is a significant component of a frozen shoulder, and it can be particularly distressing for individuals with Parkinson’s. The pain often begins gradually and may be felt deep within the shoulder, worsening at night and interfering with sleep. For those already dealing with the discomfort associated with Parkinson’s, this additional pain can have a profound impact on overall well-being. Moreover, the combination of pain and stiffness can make simple daily activities, such as dressing, reaching overhead, or even lifting a cup, increasingly difficult.

Diagnosing frozen shoulder in individuals with Parkinson’s can be challenging because symptoms may be attributed to the underlying neurological condition. In some cases, the restricted shoulder movement is mistaken for generalised muscle rigidity caused by Parkinson’s rather than being recognised as a separate musculoskeletal condition. However, a frozen shoulder has distinct characteristics that set it apart from Parkinsonian rigidity. Unlike muscle rigidity, which affects movement throughout the body, a frozen shoulder is specific to the shoulder joint and progresses through defined stages. These stages include the freezing phase, where pain and stiffness increase; the frozen phase, where stiffness is most pronounced but pain may decrease; and the thawing phase, where mobility gradually improves. Recognising these phases is crucial in distinguishing a frozen shoulder from Parkinson’s related movement issues.

Treatment for frozen shoulder in individuals with Parkinson’s requires a comprehensive approach that addresses both conditions simultaneously. Physiotherapy plays a crucial role in managing a frozen shoulder, helping to improve the range of motion and reduce stiffness. Gentle stretching exercises, passive mobilisation, and targeted movements guided by a physiotherapist can prevent further deterioration and aid recovery. However, given the movement difficulties associated with Parkinson’s, physiotherapy should be tailored to the individual’s capabilities and limitations.

Pain management is another essential aspect of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics may be used to relieve discomfort, although medication choices should be carefully considered to avoid interactions with Parkinson’s medications. In some cases, corticosteroid injections into the shoulder joint can provide temporary relief by reducing inflammation and pain. However, these injections do not address the underlying cause, and their effects may be short-lived.

In addition to conventional treatments, movement-based therapies such as tai chi and yoga can be beneficial for both frozen shoulder and Parkinson’s. These practices promote flexibility, balance, and gentle movement, which can help counteract stiffness and improve overall mobility. Hydrotherapy, which involves performing exercises in warm water, is another option that can provide pain relief while allowing for greater ease of movement.

For individuals with Parkinson’s, optimising overall disease management is crucial in addressing musculoskeletal complications like a frozen shoulder. Parkinson’s medications, such as levodopa, help improve movement and may indirectly benefit shoulder mobility by reducing muscle rigidity. However, they do not specifically target frozen shoulder, so additional therapies are often necessary.

In severe cases where a frozen shoulder significantly impacts daily life and conservative treatments fail to provide relief, surgical intervention may be considered. Procedures such as shoulder manipulation under anaesthesia or arthroscopic capsular release can help restore movement by breaking up adhesions within the joint. However, surgery is generally regarded as a last resort and may not be suitable for all individuals with Parkinson’s, especially those with advanced disease.

Preventative measures can also play a role in reducing the risk of frozen shoulder in individuals with Parkinson’s. Regular physical activity, even in the early stages of Parkinson’s, can help maintain joint mobility and reduce stiffness. Stretching exercises that target the shoulders and upper body can be particularly beneficial. Maintaining good posture and using ergonomic support, such as proper chair positioning and supportive pillows, can also help reduce strain on the shoulders.

The emotional impact of dealing with both Parkinson’s and a frozen shoulder should not be overlooked. Chronic pain and restricted movement can lead to frustration, anxiety, and depression, particularly when they interfere with independence and daily activities. Support from healthcare professionals, family, and patient support groups can provide reassurance and guidance in managing these challenges.

Conclusion

While a frozen shoulder can be a distressing complication of Parkinson’s disease, early recognition and appropriate management can make a significant difference in maintaining function and reducing discomfort. By addressing both the neurological and musculoskeletal aspects of the condition, individuals can improve their quality of life and retain as much independence as possible. Seeking medical advice at the first signs of shoulder pain and stiffness is essential, as timely intervention can prevent progression and facilitate recovery.