The Frozen Shoulder
Adhesive capsulitis or ‘frozen shoulder’ is a relatively common condition that involves the shoulder joint and is characterised by a spontaneous onset of pain, as well as, restrictions in both active and passive movement. It can often be highly debilitating restricting activities of daily living, work, as well as, sport and leisure. The exact cause of adhesive capsulitis is not known, however, the process involves inflammation involving the joint capsule of the shoulder causing thickening and contracture of its structure making it become adherent to the humeral head or uppermost part of the arm. This results in pain associated with movement of the shoulder joint in individuals with the condition.
The condition is said to affect around 3-5% of the general population and around 20% in people with Diabetes. Furthermore, the condition affects more women than men and can occur concurrently with other shoulder conditions, such as rotator cuff injury and bursitis.
Stages of adhesive capsulitis
The condition is often broken into distinct stages.
The first stage is often termed the ‘freezing or painful stage’. Typically patients will notice pain with movement of the shoulder joint and as symptoms progress the ability to move the shoulder joint both actively and passively becomes more restricted. This phase is associated with inflammation of the shoulder joint and typically lasts for around the 3 to 9 months.
The second stage is termed the ‘frozen’ stage. Throughout this stage of the condition shoulder pain does not necessarily worsen. Due to the pain whilst moving the shoulder joint there is often some disuse of the arm and associated loss of muscular strength surrounding the shoulder joint. The frozen stage can last from 4 to 12 months and by end of the frozen stage pain does not occur at the end of shoulder movement, however, the restriction to movement remains.
The third stage is termed the ‘thawing stage’ and involves a gradual return of shoulder movements lasting anywhere from 12 months to beyond 2 years.
Adhesive capsulitis is often diagnosed with a thorough physical examination from a medical practitioner, such as, a doctor or physiotherapist. As well as the loss of range of movement and pain depending on the stage of the condition, diagnosis is made upon excluding other causes of pathology, such as rotator cuff injuries, subacromial bursitis, trauma to the shoulder joint or cervical pathology.
There are several treatment options that are typically considered and used to manage the condition. The aim of treatment is to control and reduce pain, as well as, preserving and restoring the range of motion of the shoulder joint. Intensive physiotherapy is at the forefront of conservative management and involves the use of manual therapy in conjunction with prescribed exercises to overcome the condition.
The use of medications involves anti-inflammatories or corticosteroids that are often administered via intra-articular injections, inside the shoulder joint itself.
Another commonly used intervention is hydrodilatation. It involves injecting a sterile saline solution containing local anaesthetic, as well as, a corticosteroid into the shoulder to distend the joint capsule and break down adhesions.
Following failure to respond to conservative management, surgery may be warranted to regain shoulder movement. Arthroscopic joint capsular release may be used, whereby the joint capsule and adhesions are released using arthroscopic instruments thus allowing the shoulder joint to move with greater range of motion.
What to do
In summary, adhesive capsulitis is common condition involving pain and restriction to range of movement of the shoulder joint. Its effects can be relatively long lasting and debilitating to everyday life. The use of physiotherapy can have an effect on both pain reduction and restoration of movement and is optimal to the recovery process. It you are experiencing shoulder pain and/or restrictions to movement consult a physiotherapist at Physiohealth who can help you to get on the road to recovery.