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Frozen Shoulder/ Adhesive Capsulitis

Adhesive Capsulitis or Periarthritis of the shoulder is characterized by the development of dense adhesions,
capsular thickening, and restriction of range of motion of the joint. It is a painful shoulder condition that
is associated with stiffness and limitation in joint movements.

There may be marked a reduction in forwarding elevation and rotational movements in the shoulder during various daily life activities: for example while combing hair, taking something from your back pocket, dressing undressing activities, etc. Shoulder pain treatment is aimed at relieving pain and preserving the range of motion of the shoulder. It usually occurs between the ages of 40 to 60 years of age. The peak age is 56 and the condition occurs slightly more often in women than men. In 6-17% of patients, the other shoulder also gets affected, usually within five years and / or after the first has resolved.

Stages of Frozen shoulder:

Stage -1: characterized by a gradual onset of pain that increases with movement and is present at night. The strength of the supporting muscle group is intact. This stage usually lasts for less than 3 months.
Stage 2: Also known as the Freezing stage, characterized by persistent and more intense pain even at rest. The range of motion is restricted in all directions and cannot be restored with an intraarticular injection. This stage is typically between 3 and 9 months.
Stage 3: Frozen Stage – characterized by pain only with movement, significant adyhesions, and limited joint movements. The weakness of muscles like the deltoid, biceps, triceps and rotator cuff muscles. The Duration of Stage is between 9 and 15 months.
Stage -4: characterized by minimal pain, no inflammation but significant capsular restriction. The resolution of the condition follows stage 3 after about 12-24 months of onset with spontaneous improvement in the range of movement. The mean duration from onset of frozen shoulder to the greatest resolution is observed by 30 months.

Clinical Symptoms:

1. Night pain and disturbed sleep during acute flares.
2. Pain in motion and often at rest during the acute flares.
3. Limitation of movement usually external rotation and abduction with some limitation in internal rotation and elevation.
4. Faulty postural compensations are seen like rounded, elevated and protracted shoulders.
5. Decreased arm swing while walking.
6. General shoulder muscle weakness.

Treatment:

  • Control pain, edema and muscle guarding –
  • Joint may be immobilized in a sling to provide rest and minimize pain.
  • Intermittent periods of passive or assisted joint motion within the pain-free range & gentle joint oscillation techniques.
  • Gentle soft tissue mobilization to the neck and the area around the shoulder muscles to improve the patient comfort and minimize guarding.
  • Thermal therapy, electrotherapy, acupuncture, dry needling and kinesiology taping are also used for pain management.

Maintaining Joint integrity and mobility To restore full shoulder movement, techniques like shoulder joint mobilization and stretches, muscle release techniques and active-passive ROM exercises are instituted. With the increasing ROM, strengthening exercises are started to achieve control and maintain the restored range of movement. Simultaneously alternative mechanisms for compensating the loss of
shoulder functions are taught till such time shoulder recovers.

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