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Frozen Shoulder / adhesive capulitis

Frozen shoulder or adhesive capsulitis is a common source of shoulder pain. It occurs in about 2% to 5% of the population and commonly presents in 40-60 years old It is more common in women (70%).

The medical term for a frozen shoulder is "adhesive capsulitis". it means that your shoulder pain and stiffness are a result of the shoulder capsule inflammation (capsulitis) and fibrotic adhesions which limit shoulder movement.


What Causes Frozen Shoulder?


There is still so much that’s unknown about frozen shoulder. One of those unknowns is why frozen shoulder starts. There are many theories out there but the medical community still debates what actually causes frozen shoulder.

Health conditions such as diabetes, cardiac disease, hypothyroidism, and hyperthyroidism increase the prevalence of frozen shoulder. For example, the incidence of frozen shoulder in diabetics can be 10 to 38%. Researchers are unsure why the risk is increased in these groups.

Post-surgery is another time where there is a potentially preventable cause of frozen shoulder. Patients who are more protective of their arm tend to avoid post-operative exercises are more likely to develop frozen shoulder.


What is Known about Frozen Shoulder?


Frozen shoulder causes your shoulder joint capsule to shrink and significantly thicken, which leads to pain and a stiff shoulder joint capsule resulting in a reduced range of motion or a feeling of being “frozen” in place.


What are Frozen Shoulder Symptoms?


Frozen shoulder has three stages, each of which has different symptoms.


The 3 Stages are:


Freezing Phase one is characterized by pain around the shoulder, followed by a progressive loss of range of movement. This usually lasts anywhere from 3-9 months! Aggressive treatment should be avoided in phase 1.


Frozen.

Phase two is where stiffness or frozenness is dominate. Late phase two is generally pain-free but limited range due to the stiffness. This stage can commonly last from 9-15 months.


Thawing.

Phase three. During the final phase, there is a gradual return of the shoulder range. The stage can last 15- 24 months. This is the phase where Pilates and physio will do the most to increase range and strengthen the shoulder The average time length of natural resolution is 30 months. So any improvement in that time frame should is a BONUS!


How is Frozen Shoulder Diagnosed?


Frozen shoulder can be diagnosed only by a doctor or your physiotherapist.

A clinical diagnosis of frozen shoulder can be determined by a thorough shoulder examination. Your physiotherapist will ask about what physical activities you are having difficulty performing.


Common issues include:

Unable to reach above shoulder height

Unable to throw

Unable to quickly reach for something

Unable to reach behind your back

Unable to reach out to your side and behind

Unable to sleep on your side.


Frozen shoulder is commonly misdiagnosed or confused with other shoulder impingement. It is important to get an accurate diagnosis. Your treatment plan and recovery period will vary considerably to other shoulder conditions!


Frozen Shoulder Physical Examination


Your physiotherapist or doctor will ask you to perform shoulder movements.

Frozen shoulder has a distinct pattern of stiffness:

Lateral Rotation > Flexion > Internal Rotation.

Normally, your rotator cuff strength will still be normal with the exception of pain tolerance and inhibition. Frozen shoulders are commonly non-tender to touch, due to the pathology being quite deep. However quick movements are very painful in phase one and any fast movements such as reaching or throwing and catching are avoided.


Who is Likely to Suffer from Frozen Shoulder?


Frozen shoulder is more likely to occur in people who are 40 to 60 years old. It can be with no known cause or associated with an underlying illness or injury.

There are a number of risk factors predisposing you to develop a frozen shoulder.


These include:

shoulder trauma,

surgery,

diabetes,

inflammatory conditions,

inactivity of the shoulder,

autoimmune disease,

cervical cancer, and

hypo/hyperthyroidism.


Approximately 20% of people who have had a frozen shoulder will also develop a frozen shoulder in their other shoulder in the future.


Frozen Shoulder Treatment


Treatment for frozen shoulder depends on what stage you are in and should be made to your specific needs.

1. Freezing

Pain relief and the exclusion of other potential causes of your frozen shoulder is the focus during this phase.

Pain relieving techniques may include pharmacological medications as prescribed by your doctor. Intracapsular corticosteroid injection may be considered in this phase but it does seem to be ineffective after the first few weeks have passed. Intracapsular corticosteroid injection is considered on a case by case basis when pain is unbearable. Please seek the prompt advice of your shoulder specialist.

Very gentle shoulder mobilization, pilates (supported mobility), muscle releases, acupuncture, dry needling, and kinesiology taping for pain-relief can assist during this painful inflammation phase.

It is important not to aggravate your frozen shoulder during this phase, which is, unfortunately, a side effect of an overzealous practitioner or patient.

2. Frozen

Gentle and specific shoulder joint mobilization and stretches, pilates, muscle release techniques, acupuncture, dry needling and exercises to regain your range and strength are used for a prompt return to function. Care must be taken not to introduce any exercises that are too aggressive.

3. Thawing

Phase three is the stage that you can start to notice improvement and benefit from specific directed mobilizations, pilates, stretches, and exercises. Researchers have reported that well-prescribed shoulder mobilization and stretches are your best chance of a quicker prompt return to full shoulder movement and daily function. As your range of motion increases your instructor will be able to provide you with exercise progressions including strengthening exercises to control and maintain your newly found range of movement.



Can You Prevent Frozen Shoulder?


While the spontaneous frozen shoulder is of unknown origin, you can prevent some forms of frozen shoulder by avoiding a long period of shoulder inactivity. eg post-surgery or shoulder injury.

If you do have a shoulder or arm injury, it is always advisable to seek professional advice about exercises to help prevent a secondary frozen shoulder developing. This is especially important if you are in a high-risk category.

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