Frozen Shoulder/Adhesive Capsulitis

By Carla Cranbury, PT

What is it?

Frozen shoulder, also called adhesive capsulitis, is a gradual onset shoulder condition characterized by pain and limited range of motion. This is caused by inflammation and tightening of the shoulder capsule. Typical initial symptoms are pain midway between the shoulder and the elbow and difficulty reaching behind the back. Most women will report that they have difficulty doing up their bra and men difficulty putting on their belt.

Why does it happen?

Limited research has been able to discern one certain cause of frozen shoulder – in short, we don’t know. We do know that it is most common in middle aged women (aged 40-65) and people with diabetes. It also is more likely to occur after a virus, a lingering shoulder injury or after shoulder or upper limb surgery.

How long does it take?

Frozen shoulder goes through three main stages, each of which can take weeks to months:

• Freezing – pain is noticed and range of motion becomes progressively limited
• Frozen – pain is reduced, but range of motion is further restricted
• Thawing – pain is reduced and range of motion gradually returns

Can physio help?

Physiotherapy cannot speed up the course of the condition – everyone has to go through each of the three stages in order to recover. The total process of frozen shoulder can take one to two years to resolve.

What physio can do is help you retain function while going through frozen shoulder, decrease some pain, and ensure a full recovery. Maintaining mobility through the process is important and is where physiotherapy can help the most. Physio will also help prevent other injuries that can be caused by compensating for the frozen shoulder – this is especially significant as it is common for the other shoulder to get the same condition.

Your physiotherapist will give you exercises to maintain as much movement as possible and instruct you on how to perform them properly to ensure you are not compensating for the limited range of motion. Hands on manual therapy will help stretch out the capsule to make the exercises easier to perform. Modalities such as ice, heat, TENS, and acupuncture can also be used to decrease pain.

Though frozen shoulder can be a lengthy and frustrating process, the right care can make it more manageable and prevent any further complications.

 

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–6.[PubMed]

Greene WB. Essentials of musculoskeletal care. 2. Rosemont, IL: American Academy of Orthopedic Surgeons; 2001

Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin dependent diabetes mellitus. Br J Rheumatol. 1986;25:147–51. doi: 10.1093/rheumatology/25.2.147. [PubMed] [Cross Ref]

Bridgman JF. Periarthrits of the shoulder in diabetes mellitus. Ann Rheum Dis. 1972;74:738–46.

Hazleman BL. Frozen shoulder. In: Rockwood CA Jr, Matsen FA III, editors. The shoulder. 2. WB Saunders: Philadelphia; 1990.

Harryman DT, Lazurus MD, Rozencwaig R. The stiff shoulder. In: Rockwood Cam Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3. Saunders: Philadephia; 2004.

Why is massage therapy a good idea for everyone?

Many people think of a spa like setting when they think of massage therapy, however, a Registered Massage Therapist can work in many different locations including a physiotherapy clinic.

Massage therapy can be useful in combination with physiotherapy or as a sole treatment option depending on the issue. Even when there are no specific problems, massage therapy is a great option for the prevention of injuries, particularly for those individuals with sedentary jobs.

Massage therapy in combination with physiotherapy is an excellent option for many people. Often an injury involves more than one type of tissue, such as muscle, joint, tendon and/or ligament, and would benefit from a variety of treatments. Massage therapy can help facilitate physiotherapy treatments by addressing other components such as shortened, tight or sore muscles. This allows the physiotherapist to focus on function and mobility, as well as stretching and strengthening exercises.

As an exclusive treatment option massage therapy can help with many conditions either chronic or acute to relax and alleviate sore muscles. In addition, massage can help prevent injuries. For individuals that spend their day at sedentary work stations these positions and postures can predispose you to many aches and pains. Massage therapy can help maintain good postural health and muscle balance.

It’s all in the shoulder blade

Shoulder injuries are among some of the most common injuries that occur; luckily, the shoulder joint is an area that we have extensive knowledge in treating at BodyTech Physiotherapy. The shoulder is one of the most complex joints in the body because of its unique anatomy, structure and function. Due to the complexity of the joint, there are multiple factors that contribute to and influence the function of the shoulder. In most cases the rotator cuff muscles are the source of pain, but they are not always the cause of the problem.

The key to treating this difficult joint is a comprehensive assessment and thorough understanding of how the shoulder functions. An essential concept in treating the shoulder is building a good foundation for the shoulder muscles to work. This requires focusing on the shoulder blade because it provides a stable base for the shoulder joint. The rotator cuff muscles attach to the shoulder blade, therefore it is important for the shoulder blade to function properly in order to prevent injury to the rotator cuff. Posture and strengthening for both mobility and stability of the shoulder and shoulder blade are key concepts in rehabilitation.

At BodyTech Physiotherapy we use a comprehensive approach for both the assessment and treatment of a shoulder problem. Our assessment will focus on identifying the cause of the shoulder injury as well as the contributing factors that led to the injury. Our clinical experience and advanced physiotherapy training ensures that the entire shoulder problem is treated, not just the symptoms. In addition to correcting posture and increasing strength, we work on normalizing the pattern and coordinating the muscles involved in shoulder mobility, thus helping to prevent a re-occurrence of the shoulder injury.