What is frozen shoulder?
Adhesive capsulitis, more commonly known as frozen shoulder, is a condition characterised by the formation of excessive scar tissue or adhesions across the capsule of the shoulder joint, leading to initially painful and increasingly restricted shoulder movement.
This inevitably leads to increasing difficulty completing activities of daily living and consequently can significantly impact quality of life. Individuals with adhesive capsulitis also commonly report sleep disturbances due to pain in the affected shoulder at night.
Adhesive capsulitis can be primary or secondary. Primary adhesive capsulitis occurs spontaneously without any preceding event or specific trauma to the shoulder. Secondary adhesive capsulitis often occurs subsequent to a traumatic event such a fracture, dislocation or severe shoulder joint injury.
Adhesive capsulitis is thought to progress through three overlapping clinical phases:
The acute/painful/freezing phase: Characterised by the gradual onset or shoulder pain at rest and sharp pain in end ranges of shoulder motion, and typically lasts between 2 and 9 months.
The frozen/adhesive/stiffening phase: Pain begins to subside while shoulder motion is progressively lost. Pain is still apparent at end ranges of motion. This phase will generally last between 2 and 8 months.
Resolution/thawing phase: Progressive improvement in functional range of motion occurring spontaneously. This phase may last anywhere between 5 to 24 months.
Diagnosing frozen shoulder
Individuals with frozen shoulder will typically present with range of motion restrictions in a capsular pattern which your physiotherapist will identify. Typically, external rotation is the most limited movement, followed by abduction, internal rotation and finally shoulder flexion.
Isometric contraction of the muscles around the shoulder joint are typically not painful. A diagnosis of frozen shoulder is given if external rotation of the affected shoulder is more than 50% reduced compared to the other side, in addition a minimum of a 25% reduction in motion in two other planes of shoulder movement in the presence of the other symptoms described above.
Management of frozen shoulder
The physiotherapy approach to manage adhesive capsulitis will depend on the stage of the condition an individual presents in.
In the initial phase, very gentle mobilisation, muscle releases, dry needling and taping may be utilised. Heat packs may also be used regularly before or after mobilisation to aid in pain relief, along with education and activity modification to avoid aggravating movements. Exercises that may be prescribed include pendulums, passive supine forward elevation, passive external rotation and active-assisted shoulder ranging.
During the second phase of adhesive capsulitis, mobilisation with movement may be utilised. In the third phase exercise progressions including strengthening exercises to control and maintain increasing range of movement. NSAIDs may also be recommended by your GP to aid in the management of pain, and in some instances, intra-articular corticosteroids.
Operative management may be indicated for individuals with persistent symptoms that are unresponsive to conservative management. These options include manipulation under anaesthesia and capsulotomy.
If you have any further questions on how to best manage your frozen shoulder, please give us a call on 3061 7128.
Blog and videos by UQ Physiotherapy student undertaking clinical placement, supervised by principal physiotherapist, Winnie Lu.
Additional information
References
1. Carbone, S., Gumina, S., Vestri, A. R., & Postacchini, R. (2010). Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis. International orthopaedics, 34(3), 385–388. https://doi.org/10.1007/s00264-009-0791-4
2. Le, H., Lee, S., Nazarian, A., & Rodriguez, E. (2016). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & Elbow, 9(2), 75-84. doi: 10.1177/1758573216676786
3. Hand C, Clipsham K, Reese JL, et al. Long-term out-come of frozen shoulder.J Shoulder Elbow Surg2008; 17:231–236
4. Neviaser AS and Neviaser RJ. Adhesive capsulitis of the shoulder.J Am Acad Orthop Surg2011; 19: 536–542.