What is Frozen Shoulder?
Frozen Shoulder or Adhesive Capsulitis is a painful shoulder condition that is characterised by a lack of range of motion in most planes of motion of the shoulder. Frozen shoulder affects one shoulder at a time & is most common in middle-aged individuals between the ages of 45 & 60 who are sedentary. There are three stages to a frozen shoulder that are commonly referred to as: Stage I (the freezing stage); Stage II (the frozen stage), & Stage III (the thawing phase).
Causes of Frozen Shoulder
Frozen Shoulder is idiopathic in nature. This is the medical term used when the cause of a condition is unknown. It occurs more frequently in those who suffer with diabetics. Some have suggested an autoimmune component may be associated. An autoimmune condition is where the body erroneously attacks its own tissues as it mistakes it for a foreign body. Other potential factors include
- Shoulder disuse or immobilisation
- Poor postural alignment
- Rotator cuff (shoulder muscles) injury
- Lung & heart disease
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Stages of Frozen Shoulder
Stage I Frozen Shoulder:
Stage I is known as the freezing stage. In stage I the patient often reports several months of sleepless nights due to pain from lying on the affected shoulder. Symptoms involve an increase in shoulder pain & decreased range of motion. On examination, pain is present at the end of range of shoulder movements. External shoulder rotation is generally the most painful movement.
Stage II Frozen Shoulder
In stage II (the frozen phase) a severe limitation of movement allied with severe stiffness & pain is normally evident. This phase of the condition will generally last from between 4-12 months. The theory is that thickening of the synovium of the shoulder joint capsule takes place secondary to inflammation & that this causes the severe symptoms evident at this stage.
Stage III Frozen Shoulder
In stage III (the thawing phase) a gradual decrease in pain & inflammation. This is accompanied by a gradual increase in range of motion.
Treatment of Frozen Shoulder
To manage night pain it is best to lie on the unaffected side & place the affected arm on a pillow while minimising internal shoulder rotation. The patient may perform gentle range of motion exercises & mild isometric exercises at 25% of maximal contraction for 5-8 seconds at a time.
Manual decompression treatment may be utilised to decrease the pressure on the shoulder capsule. Stretching to improve shoulder abduction & external rotation should be the primary focus. Shoulder mobilisation techniques may also be applied to minimise capsular adhesions & increase range of motion.
Treatment of pain will continue as with previous stages. Increased in range of motion & gradual strengthening of the shoulder is critical at this phase. Moist heat may be applid to the shoulder prior to stretching the shoulder to relieve pain & stiffness.
At phase III, the goal of treatment is to gradually increase the laxity of the capsule & to continue building muscle strength of the shoulder. Exercises incorporating pulleys, wands & gym balls may be incorporated at this stage.
Prognosis of Frozen Shoulder
Schaffer et al. (1992) found that 50% of patients with frozen shoulder reported some pain & stiffness seven years after suffering from the condition.
Ref: Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long term follow up. J Bone Joint Surg Am 1992;74: 738-46.
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