Frozen Shoulder

Frozen Shoulder

‍Frozen Shoulder

By:  Anna Staehli Wiser, DPT, FAAOMPT


Adhesive capsulitis, also known as frozen shoulder, is a condition of the shoulder where there is pain and progressive loss of range of motion that persists for greater than 3 months.  Frozen shoulder is different than other types of shoulder pain, and it’s cause is not completely understood.  The condition usually begins insidiously and many times there is not an injury that precedes the onset.  In the early phases, pain can be very intense.  The inflammatory phase may last 3 months or so, followed by the “frozen phase”, where pain has subsided, but now there is extreme restriction of movement in all directions.  This frozen phase can last upwards of a year or more.  Gradually, in the final phase of this condition, the shoulder will “thaw out”, and motion will start to return.  Most people will regain functional mobility of their shoulder in 1-3 years after the onset of the condition1,2. 



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Adhesive capsulitis affects roughly 5% of the population and is more common in females3,4.  Thickening of the coracohumeral ligament followed by contracture of the entire glenohumeral joint capsule is thought to be the structural cause of limited motion in all planes5.  In the early stages, it may be impossible to differentiate frozen shoulder from other types of common shoulder afflictions, such as subacromial impingement syndrome, bursitis, or rotator cuff tendinopathy.  However, if there is gradual and persistent loss of mobility in all directions, then frozen shoulder should be considered. Frozen shoulder is diagnosed primarily in the clinic with a thorough history and physical exam, however, there is value in x-rays to rule out osteoarthritis, fracture or malignancy.  Diagnostic ultrasound and MRI can detect thickening of the coracohumeral ligament and sometimes be used to help make a differential diagnosis.  Also, injection with lidocaine can be a helpful clinical test. 


 

 

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It was once thought that people with frozen shoulder would make a complete recovery on their own.  However, the data now shows that without medical intervention, people can be left with permanent mobility deficits.  Research supports the use of antiinflammatory medications in the form of oral steroids or injection combined with physical therapy and acupuncture as the best treatment to restore full function of the shoulder in the presence of adhesive capsulitis6–9


Here at Discover Osteopractic Physical Therapy, an in-depth clinical exam will be performed to first determine what the cause of your shoulder pain is.  If it is determined that you do, in fact, have a frozen shoulder, treatment would include deep tissue massage and myofascial release, aggressive stretching of the joint in all planes, the use of acupuncture needles in the form of dry needling, and instruction in a comprehensive home exercise program.  Each visit lasts approximately 1 hour and includes a multi-modal treatment approach.


If you think you or a friend might have this condition, make an appointment and start your journey to recovery today. 


Although spinal manipulation is usually thought to be synonymous with chiropractic care, osteopractic physical therapists and osteopathic doctors are trained in spinal manipulation as well.  Soft tissue massage is usually thought to be exclusively performed by massage therapists, but this is a technique that the osteopractic physical therapist is also well trained in.  Lastly, dry needling is very similar to acupuncture in that both techniques employ the insertion of acupuncture needles and share the goal of promoting healing and reducing pain.   

 

References:

1. Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care. 2018;45(2):289-303.

2. Xiao RC, DeAngelis JP, Smith CC, Ramappa AJ. Evaluating Nonoperative Treatments for Adhesive Capsulitis. J Surg Orthop Adv. 2017;26(4):193-199.

3. Murakami AM, Kompel AJ, Engebretsen L, et al. The epidemiology of MRI detected shoulder injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics. BMC Musculoskelet Disord. 2018;19(1):296.

4. Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg. 2018;27(8):1437-1443.

5. Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological Aspect of Pathophysiology for Frozen Shoulder. Biomed Res Int. 2018;2018:7274517.

6. Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019;99(5):297-300.

7. Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. J Back Musculoskelet Rehabil. 2021;34(2):195-205.

8. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011;83(4):417-422.

9. Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil. 2014;27(3):247-273.