Treatments Classes

Frozen Shoulder

Frozen shoulder or adhesive capsulitis is associated with a capsular contracture in the shoulder joint. The cause remains unclear however can be classified as a primary or secondary cause. The primary onset is considered idiopathic while the secondary cause is subsequent to trauma or surgery to the shoulder. Frozen shoulders are more common in females, diabetics and 40-65 year olds. There are typically three phases: Freezing – gradual onset of shoulder pain with an increase in pain at end range motion and disturbed sleep due to pain lasting anywhere from 3-9 months. Frozen – pain may subside but there is a decrease in range of movement with pain at end range movement which may last for around 4 to 12 months. Thawing phase- a spontaneous improvement in range of movement which can progress for anywhere from 1-3.5 years.

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Symptoms

1. A gradual increase in pain at rest with a further increase in pain at end range of movement
2. A decrease in range of movement, you may notice it difficult to perform overhead movements, behind the back movements such as fastening your bra and grooming or dressing.
3. Symptoms may vary slightly depending on phat phase you are in; freezing, frozen, thawing

Treatments

During the painful freezing phase, provocative movements should be avoided. Range of motion exercises that are low in intensity and duration can reduce pain and muscle guarding. A pulley system may be used to passively increase the shoulder range of movement and additionally pendulum type exercises and passive stretching can be effective at controlling pain and regaining function [1][2].
Once in the second stage and pain has reduced stretching should become more aggressive in order to improve range of motion. These should be low load, prolonged stretches aiming to influence the shoulder capsule [1][2][3]. Static strengthening exercises may be included at this stage to preserve muscular strength and can be progressed in a controlled manner to include resistance bands and weights as the range of movement is restored [3]. Stretching duration can be further increased as the shoulder enters the final phase as irritability reduces [3]. Mobilisations of the shoulder joint and scapula may additionally promote the breakdown of adhered tissue and promote realignment of collagen tissue [4][5].
There is supporting evidence to utilise acupuncture as a complimentary treatment with a reduction in pain and improvement in function the main benefits. Again, the evidence supports the combination of acupuncture and exercises as the most effective option compared to acupuncture or exercise alone [6].
Corticosteroid injections can significantly reduce pain and allow rehabilitation to progress, evidence suggests a combination of steroid injections followed by physiotherapy treatment produces far greater improvements in function and range of movement than an injection alone or physiotherapy alone [7][6].
Arthrographic distensions are one of a few procedures that may be used should conservative treatment prove ineffective. They involve an injection of saline, steroid or air into the glenohumeral joint space which can disrupt adhesions and has been found to provide significant improvements for range of movement, function and pain. Again, the most effective result is a combination of the arthrographic distension immediately followed up by physiotherapy exercises [6][8].

References

1.https://www.jospt.org/doi/pdf/10.2519/jospt.2009.2916 Kelley, M.J., Mcclure, P.W. and Leggin, B.G., 2009. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of orthopaedic & sports physical therapy, 39(2), pp.135-148.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917053/ Chan, H.B.Y., Pua, P.Y. and How, C.H., 2017. Physical therapy in the management of frozen shoulder. Singapore medical journal, 58(12), p.685.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737560/ Duzgun, I., Turgut, E., Eraslan, L., Elbasan, B., Oskay, D. and Atay, O.A., 2019. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?. Journal of musculoskeletal & neuronal interactions, 19(3), p.311.
4. https://www.sciencedirect.com/science/article/abs/pii/S0003999315010667 Noten, S., Meeus, M., Stassijns, G., Van Glabbeek, F., Verborgt, O. and Struyf, F., 2016. Efficacy of different types of mobilization techniques in patients with primary adhesive capsulitis of the shoulder: a systematic review. Archives of physical medicine and rehabilitation, 97(5), pp.815-825.
5. https://academic.oup.com/ptj/article/86/3/355/2805166 Vermeulen HM, Rozing PM, Obermann WR, Cessie S, Vlieland T. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: Randomized clinical trial. Phys Ther 2006;86:355-368.
6. https://bjsm.bmj.com/content/bjsports/45/1/49.full.pdf Favejee, M.M., Huisstede, B.M.A. and Koes, B.W., 2011. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. British journal of sports medicine, 45(1), pp.49-56.
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153137/ Kraal, T., Sierevelt, I., van Deurzen, D., van den Bekerom, M.P. and Beimers, L., 2018. Corticosteroid injection alone vs additional physiotherapy treatment in early stage frozen shoulders. World journal of orthopedics, 9(9), p.165.
8. https://www.researchgate.net/profile/Rhys_Clement/publication/258424869_Frozen_shoulder_Long-term_outcome_following_arthrographic_distension/links/55fbf7fb08aeafc8ac41c800.pdf Clement, R.G., Ray, A.G., DaviDson, C., Robinson, C.M. and PERks, F.J., 2013. Frozen shoulder: long-term outcome following arthrographic distension. Acta Orthop Belg, 79(4), pp.368-74.
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