Introduction
Adhesive capsulitis effecting the shoulder can be very painful.
It is typically characterized by pain and a progressive and disabling loss of both active and passive shoulder joint range or motion, specifically effecting the gleno-humeral joint.
It effects approximately 2-5% of adults between 40 and 70 yoa, greater incidence in women and those with thyroid disease or diabetes. It is generally classified as primary or secondary (associated with trauma, pathology). Secondary is further broken down into extrinsic (outside of the gleno-humeral joint) or intrinsic, involving the gleno-humeral joint.
The pain is aggravated by movement and alleviated with rest. It tends to be worse at night.
The most common presentation is pain and restriction with external rotation with the arm bent and held in a neutral position by the side.
The condition typically progresses thru a number of stages:
Freezing phase 10-36wks
Local shoulder pain and stiffness.
Limited response to anti-inflammatory medications.
Adhesive – restrictive phase 4-12wks
Less pain, more stiffness
Pain at ends of range of motion, worse lateral rotation.
Resolution phase 12-42wks
Spontaneous improvements in range of motion.
Treatment:
As a general rule, gentle joint mobilizations within the pain range create better outcomes than pushing beyond the pain limits.
Jan, Maund and Page all reported a positive improvement with a multi-modality approach, e.g., manual mobilizations, low level laser, soft tissue therapy, exercise prescription, hot and cold packs, ultrasound and not limited to TENS. Medical and surgical interventions have included cortisone and calcitonin injections, hydro dilatation, manipulation under anesthetic, contracture releases etc. [1,2,3].
Jan, Maund and Page go on to say random control clinical trials comparing different outcomes are ‘sparse’.
Self-stretching has been shown to improve outcomes (courtesy Clinical Orthopedic Rehabilitation: A team approach. Giangarra C.E., Manske C.)
Chiropractic and Physiotherapy are well positioned to offer treatment for frozen shoulder.
Research has shown the following treatments used by Chiropractors may assist in the treatment of frozen shoulder: McKenzie Method of mechanical diagnosis and therapy (MDT), thoracic manipulation, and instrument-assisted soft-tissue mobilization over the shoulder. [4] Physiotherapists may employ ultrasound, TENS, rehabilitative exercise, laser, joint mobilisation, and muscle release techniques.
Conclusion:
Frozen shoulder is a debilitating, chronic and painful condition that responds well to multi-modality approach within the pain and range of motion limitations.
About the author:
Dr. Andrew Arnold is senior Chiropractor and Director, Back In Motion, Cranbourne.
References:
[1] Maund E, Craig D, Suekarran S, Management of frozen shoulder a systematic review and cost effectiveness analysis. Health Techno Assess. 2021;16(11):1-264.
[2] Page MJ, Green S, Kramer S, et al. Manual therapy, and exercise for adhesive capsulitis (frozen shoulder): systematic review. Cochrane Database Syst Rev. 2014;8:CD-11275
[3] Jain TK, Sharma MK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder / adhesive capsulitis: a systematic review. J Back Musculo-skeletal Rehabil. 2014;27(3):247-273