What is Frozen Shoulder?
Adhesive Capsulitis, also known as ‘Frozen Shoulder’ is a condition presenting with pain and progressive restriction in both active and passive movement of the glenohumeral (shoulder) joint.
It is a pathological process where the body forms scar tissue or adhesions over the glenohumeral joint. This results in pain, stiffness, and loss of function of the joint, which can reduce the individual’s quality of life. It can occur idiopathically or following shoulder surgery or trauma.
Primary adhesive capsulitis: This type occurs spontaneously without any event causing it. This type also usually occurs in the non-dominant extremity but in 40-50% of cases, it occurs bilaterally.
Secondary adhesive capsulitis: This type occurs after trauma to the shoulder such as surgery or an injury.
About the shoulder.
Inside the shoulder, there is a ball and socket joint which is made up of the humerus, shoulder blade and collarbone. Within this area the tendons of muscles from the arm, upper back and chest insert into and around the joint. Surrounding all these structures is a strong connective tissue known as the shoulder capsule, which is what is affected in a frozen shoulder.
The Process.
Stage 1: shoulder pain, especially at night, preserved motion
Stage 2: begin to develop stiffness
Stage 3: global loss of range and pain
Stage 4: chronic stage, persistent stiffness but minimal pain. Maybe some slow improvement in shoulder movements
The initial freezing stage presented with increasing pain and a progressive loss of shoulder range. This stage typically lasts from 6 weeks to 9 months.
During the next stage, pain may lessen but the stiffness and lack of range will remain causing difficulty with daily functional tasks. This stage typically lasts 4 to 6 months.
The last stage is where the shoulder range begins to improve until it returns back to or close to baseline range. This stage can take up to 6 months to 2 years.
Who is at higher risk?
- Females (70%)
- Aged over 40 years (84% fall between 40-59 years old)
- Preceding trauma
- Genetic predisposition – white patients, HLA-B27 positive, family history
- Prolonged immobilization of the GH joint
- Comorbidities
There has been no clear cause determined as to why an individual gets a frozen shoulder, although there are some factors that place you at a higher risk. These include diabetes, hypothyroidism, hyperthyroidism, Parkinson’s and cardiac disease. In addition to that, those who have their shoulder immobilised for a period of time due to surgery, fracture, or another injury are also at higher risk.
What can Physiotherapy do?
Physiotherapy is the first line of treatment and can provide a form of non-operative management for frozen shoulders with the long-term goal towards restoring the shoulder to a pain-free and functional joint.
Management includes:
- Education regarding the prognosis of the condition for greater understanding and reduced frustration
- Pain-relieving movements
- Heat/ice modalities
- Stretching to maintain then improve joint range throughout phases
- Strengthening to maintain and improve function throughout phases
What can you do?
- Ask your physiotherapist questions so you can gain a better understanding
- Speak to your GP for nonsteroidal anti-inflammatory drugs
- Utilise heat/ice modalities for pain relief
- Maintain stretching and strengthening exercises recommended by your Physiotherapist to maintain and improve the joints range and function
Unsure if you have a frozen shoulder? Book in for an assessment for a diagnosis and how best to treat the condition.
Written by physiotherapist, Maggie Smith.
References
https://orthoinfo.aaos.org/en/diseases—conditions/frozen-shoulder/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917053/