Frozen shoulder, also known as adhesive capsulitis, is a condition affecting the joint of the shoulder causing pain and stiffness. Frozen shoulder is very common in diabetic patients . In this condition, the shoulder joint becomes stiff and painful. Frozen shoulder begins gradually, worsens over time. It may persist up to three years, and then it finally goes away.There are 3 main stages to the condition:
1. Pain and freezing stage
2. Frozen stage
3. Thawing stage.
Freezing Stage: The problem develops gradually as the movement in the shoulder becomes painful, and it starts locking up. The stage lasts from 3 months to 9 months. In frozen shoulder, the most affected motion is external rotation (turning the arm outwards).
Frozen Stage: In this stage, the pain is reduce and not sharp, but the shoulder becomes stiffer and there is significant loss of range of motion . This stage lasts from 4 to 6 months.
3. Thawing Stage: This is the last stage in which the range of motion improves. During this stage, the pain is less and range of motion resolves, although not completely in some cases. This stage may last from six months to two years.
The shoulder joint is a ball and socket joint. The ball is the upper end of the long bone of the arm and the socket is attached to the shoulder blade. The ball and socket joint is connected with a tissue called the joint capsule. This joint capsule is lined with a connective tissue called the synovium. It is thought that the first stage of frozen shoulder is an inflammatory condition of this lining or synovium and this progresses to a thickening of the joint capsule or fibrosis.
Causes
The exact cause of Frozen Shoulder remains unclear however we do tend to see it in particular groups of people. Females are much more likely than males to get frozen shoulder (70% compared to 30%) however if males do get it they tend to get it worse and for longer.
Idiopathic (Primary) frozen shoulder occurs spontaneously without an event to set it off. There are thoughts that the excessive inflammatory response that creates this may be an abnormal immune system response. Idiopathic frozen shoulder is most likely to occur between the ages of 40-60. Other causes could be repetitive movement of shoulder joint, recent trauma, diabetes .
Physiotherapy Diagnosis
An accurate diagnosis of Frozen Shoulder can be made by your physiotherapist with a comprehensive subjective history and thorough examination. Your physiotherapist may also decide to confirm the diagnosis with an MRI or a diagnostic ultrasound.
As stated above most cases of true ‘Frozen Shoulder’ will take a number of months to recover, others may take even longer depending on how quick the thawing stage can commence.
Frozen Shoulder Treatment
Frozen shoulder is known as a self-limiting condition which basically means that it tends to settle itself down over time, but it is important to educate the patient about what is going on and get them to keep moving their shoulder within a comfortable range to minimize loss of range and function.
Treatment of frozen shoulder aims to reduce pain and restore mobility in the shoulder. Following lines of therapy may be adopted to combat the situation.
Pain Killers
Physical Therapy
Steroid Injections
Joint Distention
Surgery
Physiotherapy Treatment
The management of Frozen Shoulder can be greatly assisted by your physiotherapist. Your physio can use various techniques to help manage pain and restriction, help decrease the effect on your daily life and effectively monitor any progression or advancement into different stages of the condition. Physiotherapy can be used at each stage of frozen shoulder for different reasons. During the initial painful stage, education on what is happening can help reduce fear. As just mentioned it is important to maintain movement and function so exercises at this point within pain limits play an important role in minimize deterioration.
Physiotherapy becomes particularly important in the thawing stage for exercises to assist with restoring range, strength and function. Soft tissue work may be used as a pain relief technique for some patients.
Physiotherapy treatment is widely focused at maintaining as much shoulder movement as possible, managing the pain and when in the thawing stage ensuring a speedy recovery and return to normal shoulder movements.
Physiotherapy treatment would include
Ultra sound & LASER Therapy
IFT
Dry needling
Manual mobilization
Soft tissue technique MFR
Cupping therapy
For Home Exercises
Pulley is an essential tool to get full shoulder range.
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