Frozen Shoulder – What is it?

Frozen Shoulder – What is it? By: CHE PHILLIPS

The term ‘Frozen Shoulder’ is known more correctly as ‘Adhesive Capsulitis’. There are though many conditions can cause a stiff and painful shoulder, yet it was not clearly defined until after 1945. Even though each term posses different pathological entities, the terms are however used interchangeably in medicine today. Adhesive Capsulitis is characterized by painful and gradual loss of shoulder movement resulting from thickening (fibrosis) and ultimate seizing (contracture) of the shoulder joint.

Adhesive Capsulitis affects between 2 to 5% of the population, generally over 40 year olds and most commonly females. Because the majority of people affected are older and female, it is thought there exists a hormonal component yet this is still to be shown in the research. Interestingly the non-dominant side is usually involved and 20-30% of patients affected will develop the condition in the opposite shoulder as well. 30% of people affected will report trauma associated to the affected shoulder.

There are two classifications true Adhesive Capsulitis will fall under, either primary or secondary. Primary Adhesive Capsulitis is where the inflammation and fibrosis of the shoulder joint occurs from unknown causes. Secondary is when the stiffness can be attributed to a known injury or condition such as post surgical complications. Further evidence that there is an underlying hormonal component is its association with other conditions such as thyroid dysfunction, Dupuytrens contractures, autoimmune disease and breast cancer treatment.

Over the 18-24 months it generally takes for Adhesive Capsulitis to resolve, there are 4 stages it will progress through.   

  • Stage 1. – characterized by gradual onset pain.

- achy at rest, sharp pain with movement.

- pain at night, inability sleep on affected side.

- deep pain on touch or stretch.

- early loss of outward rotation.

- duration of symptoms in stage 1 less than 3 months.

  • Stage 2 – combination of joint fibrosis and contracture.

- known as the ‘freezing stage’.

- if pain persists, may be more severe particularly at night.

- motion restricted in all directions.

- limitation in movement can not be improved with shoulder joint anesthetic injection.

  • Stage 3 – stage of maturation, known as the ‘frozen’ stage.

- significant stiffness predominant complaint.

- pain minimal at end range of movement and occasionally at night.

- no improvement with shoulder joint anesthetic injection.

- symptoms present in stage 3 for 9-15 months.

  • Stage 4 – known as the ‘thawing’ stage.

- pain minimal

- gradual improvement in movement

Treatment for Adhesive Capsulitis will depend on which stage the shoulder is at during healing process.

  • Stage 1 - physiotherapy goals are to interrupt inflammation, diminish pain

- patient education, activity modification, gentle movement

- shoulder blade stabilization, shoulder joint mobilization, hydrotherapy, home exercise program.

- Corticosteroid injections can be used if needed to help inflammatory stage pass.

  • Stage 2 – goals same as stage 1 plus minimizing joint contracture, restrictions in      motion, reducing pain and inflammation.

- physiotherapist treatment to move/glide shoulder joint to increase joint movement.

  • Stage 3 and 4

- Movement can only be pushed if no pain.

- strengthen shoulder blade muscles.

- when full movement returns, strengthen shoulder stabilizing muscles.

The take home message is if you have been diagnosed with Adhesive Capsulitis or “Frozen Shoulder” is be patient, as it will get better with the correct treatment at the appropriate times and generally within the 18-24 month period. If you display any of the symptoms or think you in fact do have Adhesive Capsulitis, best to see a qualified physiotherapist for a review as soon as possible.

BY:Ché Phillips,

 Physiotherapist and Sports Scientist

Ba. Phty (Hons), B. Ex. Sc.

References

Barnes, C., Scott, J., Steyn, J. V., & Fischer, R. (2001). The effects of age, sex, and shoulder dominance on range of motion of the shoulder. Journal of Eldow Surgery, 10, 242-246.

Bunker, T. (2009) Time For a New Name for Frozen Shoulder – Contracture of the Shoulder. Shoulder and Elbow, 1, 4-9.

Kelly, M.J., Mcclure, P.W., Leggin, B.G., (2009) Frozen Shoulder Evidence and a Proposed Model Guiding Rehabilitation. Journal of Orthopedic and Sports Therapy, 39(2), 135-148.

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Magee, D.J. (2006) Orthopedic Physical Assessment, 4th ed. Elsivier Sciences USA

Neviaser, A.S. and Hannafin, J.A. (2010). Adhesive Capsulitis – A Review of Current Treatment. The American Journal of Sports Medicine, 38(11), 2346-2356.

 

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