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Overview
Frozen shoulder, medically known as adhesive capsulitis is a condition associated with significant stiffness and pain around the shoulder joint. The condition is typically develops and resolves within 1-3 years, during this time muscles may become weaker due to atrophy.
Signs and Symptoms
Frozen shoulder is marked by the severity of stiffness of shoulder movements (actively and passively) especially in external rotation (rotation outwards). Sleep disturbance due to pain is common among patients with frozen shoulder. There are 3 stages to frozen shoulder
- Freezing stage. Increase in severity of symptoms. The shoulder starts to lose its range of motion. Pain also increases, especially during sudden movements
- Frozen stage. Shoulder becomes significantly stiff in any movement. Pain may begin to subside during this time
- Thawing stage. Range of motion begins to improve.
Causes
The primary cause of frozen shoulder is unknown, it can occur spontaneously. However, secondary frozen shoulder can occur after shoulder surgery or injury, when the shoulder has been immobilised for a sustained period of time.
Risk Factors
- post surgery (e.g rotator cuff repair, shoulder arthroplasty)
- Females > Males
- > 50 years old
- Diabetic patients
- After a stroke
Physiotherapy Treatment
The aim of physiotherapy for frozen shoulder is to control the pain and preserve range of motion and strength of the shoulder. Research has shown joint mobilisation and gentle exercise is the most effective treatment. Exercises such as pendullar swings, finger wall climbs and active assisted movements with ropes/pulley/bar. Joint mobilisation, gliding of the shoulder joint backwards can help with external rotation. Trigger point release of rotator cuffs (specifically subscapularis) and latissimus dorsi can also be helpful to reduce pain and increase range.
Other Treatments
- Steroid injection
- Shoulder manipulation under anesthesia
- Surgery
References
Page et al. (2014). Manual therapy and exercise for adhesive capsulitis.
Page P. & Labbe. (2010). Adhesive capsulitis: use the evidence to integrate your interventions.
