Frozen shoulder can be a very frustrating condition for both patients and practitioners. For the patient, it is very painful and can take quite a long time to resolve. For the practitioner who tries to keep abreast of the current literature, it seems that there is still quite a lot that we don’t know about this condition and some of our previous understandings have been disproven.
Frozen shoulder is a condition where the patient loses range of motion in the shoulder in a very unique way. There’s often no obvious, dramatic event that starts the process. In terms of x-ray findings, nothing can explain this loss of motion. It’s just a very slow process of change whereby the shoulder painfully loses range of motion in the absence of any obvious causative factors.
For a long time, frozen shoulder has been referred to as adhesive capsulitis. Recently, the term frozen shoulder contracture syndrome has been coined, perhaps lending to the idea that this condition may not be as inflammatory as once thought. The term “capsulitis” implies inflammation in the capsule of the shoulder, yet some recent literature suggests that there often aren’t many inflammatory cells present! Despite this, there is a lot we do know about frozen shoulder.
Risk factors for frozen shoulder include genetics, diabetes and hypothyroidism. There are three phases of frozen shoulder contracture syndrome. The initial stage is frozen/pain, followed by freezing/stiffness and then finally thawing/recovery. Unfortunately, the average length of this condition is over thirty months! (Keep in mind though, many patients resolve their condition in a much shorter time; this is just the statistical average)! In terms of what is happening in the joint, we have now learned that the capsule is not adhered to the humeral head as once thought. Instead, frozen shoulder contracture syndrome is primarily attributed to a development of fibrosis (scar tissue) and neovascularity (altered blood supply to the area). Other than the risk factors mentioned above, we don’t completely understand why this happens, especially to those without the aforementioned risk factors.
There are various treatment options for frozen shoulder. Those include acupuncture, laser therapy, joint mobilization, graston technique and massage therapy to name a few. Cortisone injections and short wave diathermy have also been mentioned in the literature as options. Home exercises focusing on mobility and strengthening are an integral component of recovery. As mentioned earlier, it is important that patients and practitioners have a realistic expectation for recovery. Although it is reasonable to expect that the shoulder will recover to pre-injury status, this may not occur for quite some time.
Shoulder pain? Give us a call…we can help!
Lewis J. Frozen shoulder contracture syndrome – aetiology, diagnosis and management. Manual Therapy 2015; 20(1): 2-9.