Photo credit: Kaitlin Walsh - Abstract Anatomy Artist
Adhesive capsulitis, which is commonly known as frozen shoulder, is a condition that results in painful, and heavily restricted movement of the shoulder joint, which spontaneously resolves, within a varied time frame.
How does this happen?
The pathology behind frozen shoulder is still contentious and poorly understood, however, the most recognized pathology is inflammation of the synovium (the substance within your joint), which is mediated by cytokines (proteins secreted by the immune system, which are used for signalling/ communication within the body), causing an increase in fibroblasts (cells of the connective tissue) within the joint capsule. This, along with the adhesions that form within the joint, lead to restrictions in movement.
Why does it come on?
Frozen shoulder is predominantly an idiopathic condition, meaning that it comes on for no specific reason. Occasionally, we can have secondary frozen shoulder, which is the result of a specific factor or event. This can include post-injury, post-stroke or post-surgery, where pain may lead to restriction of movement and cause stiffening of the joint.
Other factors which can increase you chance of developing frozen shoulder include:
Aged between 35-65 years
A past medical history of frozen shoulder increases the risk of the other shoulder developing frozen shoulder
History of shoulder surgery
Diagnosis of frozen shoulder is generally done via your primary health care practitioner (osteopath, GP etc) after listening to your medical history and doing a thorough examination of your shoulder.
Some key things your practitioner may look for, include:
Insidious onset of shoulder pain with no apparent injury
Restricted movement of the shoulder, both actively and passively
Reduced overhead and external rotation movement
Struggling with sleep
Additionally, you may be referred for imaging, including ultrasound and MRI, to rule out other pathologies of the shoulder (rotator cuff injury, bursitis, impingement, arthritis etc), but it is rarely used to confirm the diagnosis of frozen shoulder, but rather to rule out another pathology.
The development of frozen shoulder goes through three overlapping stages:
Freezing (2 to 9 months): Early
Frozen (4 to 12 months): Developed
Thawing (12 to 42 months): Developed
Freezing: An initial, painful phase includes predominant pain, that is worse at night, with gradually increasing glenohumeral joint ROM restriction.
Frozen: The second phase includes stiffness and limited shoulder joint motion, but with less pain than that at the “freezing” stage.
Thawing: The third (recovery) phase includes the gradual return of range of motion.
What can we do for it?
The treatment of frozen shoulder is complicated, due to the poor understanding of the underlying cause, management generally revolves around addressing the symptoms with manual therapy and pharmacological intervention.
At the beginning of the condition (freezing phase) the focus is on pain management, reduction of inflammation and patient education.
As manual therapists, we will help with reducing pain and maintaining range of movement within the shoulder. Treatment may include gentle mobilization techniques, muscle release and stretching. You will also be prescribed some gentle range of movement and stretching exercises to do yourself, to slow the freezing phase.
Due to disuse, the muscles surrounding the shoulder can waste and lose strength. Once the freezing and frozen stages are done, the aim of treatment is to regain movement, rebuild strength, and resilience in your shoulder. We address this via at home mobilization, strengthening and stretching exercises and management stratergies.
More invasive procedures, such as cortisone injections, hydrodilatation and surgery, may be advised, on a case by case, basis.
While frozen shoulder can be frustrating, fortunately it will eventually resolve, occasionally some pain and stiffness may remain afterwards. Patience is vital while dealing with this condition and here at Retrain Health we can help get you better quicker. If you would like further information or help regarding frozen shoulder, call us on (02) 6680 7447 or send us an email.
Retrain Health is based in the Northern Rivers, NSW. From our Byron Bay and Ballina clinics, our team provides a range of quality healthcare services and products.
Retrain Health offers osteopathy, remedial massage and strength and conditioning, and PT sessions with qualified practitioners.
If you are interested in finding out more information or would like to book an appointment, please contact the clinic by phone (02) 6680 7447, send us an email or click here to book an appointment online.