Frozen Shoulder

Definition

Frozen shoulder, also called adhesive capsulitis is a common disorder that causes pain, stiffness, and loss of range of motion in the shoulder. This condition will generally gets worse with time if it’s not treated. Frozen shoulder occurs when the connective tissue (joint capsule) surrounding the shoulder becomes stiff, and inflamed. The joint capsule contains the ligaments that attach the humeral head to the shoulder socket firmly holding the joint in place. It is called frozen shoulder because the more painful the shoulder becomes the less likely it is to be used resulting in more stiffness or appearing frozen.

Who’s at risk of developing frozen shoulder?

Age:  most commonly effects people aged between 40 and 60 years old. In Japan this condition is know as the 50 year old shoulder.

Gender: Women are more likely to develop frozen shoulder.

Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep the shoulder from moving such as using a sling or brace. Examples include a rotator cuff tear and fractures of the shoulder blade, collarbone or upper arm.

Diabetes: Between 10 and 20 percent of individuals with diabetes develop frozen shoulder. Other health diseases and conditions: Includes stroke, hyperthyroidism, Parkinson’s disease and heart disease. Why other diseases and conditions increase the risk of developing a frozen shoulder is not clear

Diagnosis

Frozen shoulder can be diagnosed in the physiotherapy clinic. This means imaging is not required and diagnosis can be made by your physiotherapist. However an MRI scan can be used to confirm the diagnosis but is not necessary. This is generally done by taking a thorough subjective and objective history to confirm the diagnosis.

Treatment options

Frozen shoulder generally gets better over time. Symptoms may last from 6 months to 3 years. Physiotherapy treatment will focus on maintaining and improving range of movement and strength while managing pain. 90% of people with frozen shoulder will recover with non-surgical intervention (Cho et al. 2019)

Nonsurgical Treatment

Most people with frozen shoulder improve with relatively simple treatments to control pain and restore motion.

Non-steroidal anti-inflammatory medicines: Drugs like aspirin and ibuprofen reduce pain and swelling.

Steroid injections: Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.

Hydrodilatation: If your symptoms are not relieved by other nonsurgical methods, your doctor may recommend hydrodilatation. This procedure involves gently injecting a large volume of sterile fluid into the shoulder joint to expand and stretch the shoulder joint capsule. Hydrodilatation is conducted by a radiologist who uses imaging to guide the placement of fluid.

Physiotherapy: There should be a tailored home exercise program to follow to meet the specific needs, goals and pain levels of each individual patient.  In clinic treatment can include:

• Passive and active stretching of the shoulder and joint capsule.
• Joint mobilisation,
• Dry needling,
• Acupuncture,
• Soft tissue massage
• Heat.
• Exercise: stretching, resistance training, mobility exercise