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Frozen Shoulder

Frozen shoulder also known as adhesive capsulitis is a common cause of shoulder pain in elderly population. This condition is commonly confused with rotator cuff injury. This is a self limiting disorder that gets better itself over a period of 2 or more years.

The patient has a peculiar pattern of symptoms that results into severe shoulder pain especially at night, loss of shoulder function and eventually stiffness.

The shoulder pain and stiffness is as a result of shoulder capsule inflammation (capsulitis) and fibrotic adhesions that limits the shoulder movement so the condition is termed as Adhesive Capsulitis.

CAUSES:

The condition can arise spontaneously without any known cause (idiopathic reasons). Though common causes that can result into frozen shoulder are-</p

  • injury to the shoulder
  • diabetes
  • hypertension
  • thyroid dysfunction
  • autoimmune disorder
  • prolong immobilization
  • long standing cases of cervical spondylitis
  • post surgical intervention around shoulder region, etc

SYMPTOMS:

A frozen shoulder progresses through three stages and each stage has different symptoms.

The Stages are:

  1. Freezing – this stage is characterized by pain in and around the shoulder initially, which may radiate till above the elbow joint. There may or may not be loss of shoulder range of movement but progressive pain throughout the range. The pattern of movement loss will be like external rotation mostly affected followed by abduction and then internal rotation. Sudden movements are very painful, so, patients avoid any fast movements such as reaching or throwing. This phase is also known as the RED phase as the capsule appears red under arthroscopic view.
  2. Frozen – the pain gradually reduces with no further loss or regain of range of shoulder movement. This stage is also known as the PINK phase as the capsule appears pink under arthroscopic view.
  3. Thawing – there is gradual return of range of shoulder movement but not complete because of weakness due to disuse of the shoulder. This stage is also known as the WHITE phase as the capsule appears white under arthroscopic view.

Each stage can last for an average of 6 to 8 months if left untreated. Sudden movements are very painful so patients are very cautious and avoid any fast movements such as reaching out for something.

DIAGNOSIS:

A case of frozen shoulder can be easily diagnosed in the clinic on the basis of clinical signs and symptoms of the patient. A qualified physiotherapist should thoroughly examine to rule out other shoulder pathology.

Common complaints of a patient with frozen shoulder are

  • Unable to reach above shoulder height,
  • Unable to throw a ball,
  • Unable to quickly reach for something,
  • Unable to reach behind the back e.g. hook/unhook bra or tuck-in the shirt.
  • Unable to comb hair,
  • Unable to sleep on the affected side.

Other diagnostic tools like an x-ray or an MRI are rarely used.

NOTE: Frozen shoulder can be misdiagnosed or confused with rotator cuff injury by inexperienced Physiotherapist. Accurate diagnosis is very important as treatment varies considerably in either of the cases.

TREATMENT:

Physiotherapy treatment for frozen shoulder depends on what stage you are in, and is tailored to your specific needs.

1. Freezing
The physiotherapy treatment in this phase aims to reduce the pain through therapeutic modalities and techniques like gentle mobilization, muscle releases, dry needling and kinesiology taping.
Intrarticular corticosteroid injection can be considered if pain is unbearable, one needs to see an orthpaedic doctor for this option.

2. Frozen

During this phase treatment aims to enhance the range and strength of shoulder movements through joint mobilization and capsular stretches, muscle release techniques, dry needling and exercises for a prompt return to function. The above mentioned techniques will also help relief pain. A graded exercise programme is needed as progressing to quickly may aggravate the symptoms.

3. Thawing
The only aim as a physiotherapist during this phase is to restore Shoulder movement but it may get difficult at times is muscle wasting is severe.

Prevention:

Frozen shoulder can be prevented by maintaining shoulder mobility during the post operative period of inactivity. Individuals who are at high risk should keep doing gentle shoulder movement to prevent the problem. People who had met any shoulder injury should undergo proper physiotherapy to prevent the occurrence of frozen shoulder.

For more information, contact Dr. Roshan Jha at PAIN FREE PHYSIOTHERAPY CLINIC.