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Frozen shoulder

Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. It is often caused by inflammation of the joint capsule; the tissue surrounding the shoulder joint together with fibrotic adhesions that limit shoulder movement.

Symptoms typically begin slowly and worsens progressively. Over time, symptoms get better, usually within 1 to 3 years and most commonly affects adults between 35-60 years with women being the most prevalent.

Causes;

  • Idiopathic (not known)
  • Association with underlying illnesses such as stroke
  • Post-surgical instances in the guard to protect the arm.

Signs and symptoms

  • Pain with any shoulder movement
  • Stiffness that inhibits shoulder movement
  • Difficulty sleeping on one side.
  • Loss or reduced shoulder range of motion

Mechanism;

Frozen shoulder causes the shoulder joint capsule to shrink (to < 5cm3) and thicken (from 1mm to 5mm) leading to pain and stiffness hence reduced shoulder range of motion.

Stages;

Frozen shoulders occur in 3 stages;

  • Freezing
  • Frozen
  • Thawing
  • Freezing/ painful phase.

    This stage is characterized by slow onset of pain around the shoulder at rest followed by progressive loss of shoulder motion. It lasts from 3-9months.

  • Frozen/Stiffening phase.

    Stiffness is dominant in this phase. Pain starts to reduce and is apparent only at extremes of movement. There is progressive loss of joint motion due to stiffness and lasts between 9-15months.

  • Thawing/Resolution phase.

    In this phase, there is significant progressive improvement in functional range of movement which lasts between 15-24months. It is, however, characterized by mild to no pain.

Common issues associated with frozen shoulder include;
Inability to;

  • Reach above shoulder height.
  • Quickly reach out to something
  • Reach behind your back to tie the bra or tucking a shirt.
  • Reach side to side; fastening a seat belt.
  • Sleeping on the side
  • Throw a ball.

Risk Factors leading to a frozen shoulder;

  • Shoulder Trauma
  • Post-surgical complications
  • Diabetes Mellites
  • Inflammatory conditions (Rheumatoid arthritis)
  • Shoulder inactivity
  • Autoimmune conditions
  • Tonic seizures

Diagnosis

  • Diagnosis can be derived from the clinical signs and symptoms.
  • Physical shoulder examination
  • Shoulder arthroscopy
  • X-RAYs and MRIs to rule out other shoulder issues.

Treatment

  • Pharmacological medication; corticosteroids injections and analgesics to relieve pain.
  • Physiotherapy
  • Lifestyle modification.
  • Surgical intervention.

Physiotherapy management.

Physiotherapy management is based on pain reduction and improving shoulder mobility. This is achieved through;

  • Electrotherapy approach,
  • Stretching,
  • Strengthening
  • Range of motion exercises.

Other physiotherapy options include;

  • Postural realignment,
  • Acupuncture,
  • Taping
  • Soft tissue manipulations.

Compiled by Spine Health and Sports Injury Clinic.