Frozen Shoulder (Adhesive Capsulitis)

There are three clinical stages of the condition: freezing, frozen and thawing. In the freezing or acute stage moderate to severe pain exists that limits all shoulder movement. In most instances, the patient cannot recall any specific even that triggered the pain. The pain interferes with sleep, and in many instances causes patient to seek prescribed pain medication. In the frozen or middle phase, pain decreases gradually but without very much improvement in motion. The final or thawing phase is marked by slow and gradual return of motion and may be as short as 12 months but may last for years. Adhesive capsulitis has typically been classified into two forms, primary and secondary. In the primary form, no known causes can be identified. The secondary form is associated with trauma or other illnesses or events. Generally, the cause of adhesive capsulitis remains unknown. The condition tends to affect women more than men, occurs in people after their 40’s, does not show a particular preference for handedness, and can on occasion occur on both shoulders.

FROZEN_SHOULDER

The most accepted theory is that adhesions develop between or within the capsule of the shoulder. Some individuals may be predisposed, such as those with diabetes, hyperthyroidism, lung disease and those who have had a heart attack.  It has been shown that, contrary to logic, this process is not due to immobilization (lack of movement). This process begins as an inflammatory process that resolves with scar tissue formation.

Because of the favourable natural history, patients can generally expect a good outcome, and in most cases conservative treatment is successful. Some patients will have residual signs and symptoms years after the onset of their disease. Mostly this is pain-free, mild loss of range of motion. Treatment is aimed at controlling pain, increasing range of motion in the shoulder and breaking down scar tissue with Physiotherapy Targeted Soft Tissue Therapy, and Acupuncture. A series of progressive Functional Rehabilitation exercises are used to regain proper movement of the shoulder.