Frozen Shoulder

What is a frozen shoulder?

Frozen shoulder or adhesive capsulitis, remains one of the most mysterious shoulder conditions due to the fact that we still don’t know how it happens. Typically it has an insidious onset, and clinically it has been observed that patients with diabetes mellitus, thyroid disease or a previous episode of contralateral frozen shoulder are at higher risk. It is more prevalent in female and male (Kelley et al, 2013). In Japan and China frozen shoulder is called “Fifty year old shoulder”, which described roughly the average age of the onset – between 45 to 65 years old (Maund et al, 2012 & Kelley et al, 2013).  

Diagnosis

To date, there is not a gold standard test to diagnose frozen shoulder. Usually it is a diagnosis of exclusion. However, to fit in the diagnosis of frozen shoulder, the patient has to at least present with the following characteristics: a gross loss of both active and passive range of movement (Kelley et al, 2013). Generally speaking, there has to be a loss of over 25% of range of movement in at least two movement planes, or there is a loss of 50% passive lateral rotation compared to the opposite arm, or there is less than 30 degrees of lateral rotation.

There have been clinical practice guidelines developed based on the international classification of functioning, disability and health in assisting the diagnosis of frozen shoulder and differential diagnosis through medical screening and clinical tests by physiotherapists (Kelley et al, 2013). It is crucial to have early screening to have an accurate diagnosis and appropriate treatment.

Frozen shoulder is a relatively long lasting condition which can last from usually 12 to 42 months, and 30 months being the average (Lewis, 2015). There are three main phases during the development of the condition. The first phase is called the painful phase (2-9 months), where the shoulder gets progressively stiffen and there is loss of movement and increases in associated pain. This is due to the presence of inflammatory substances that lead to the development of scarring. The second phase is the freezing phase (4-12 months), which the loss of movement plateau and the associate pain is diminished or gone. Pathoanatomically, it was found that during this phase there was contracture of the fibrous tissues at the joint capsule and the surrounding ligaments, which lead to a reduced joint volume and movement.               

The last phase is called the thawing or resolution phase, which shoulder starts to regain movement. Although frozen shoulder was somewhat believed to be self-resolved over time, long term functional loss or symptoms was reported (ranging 2-20years) from previous studies (Hand et al, 2008).

Treatment of frozen shoulder

There have been various studies in looking at the effectiveness of conservative or surgical managements. There was strong evidence that favoured the use of cortisone injection and laser therapy in short term; moderate evidence for mobilisation techniques in short and long term, and combined hydrodilitation and physiotherapy in short and long term (Favejee, Huisstede, & Koes, 2011 & Watson et al, 2006). There are some other treatment techniques such as acupuncture, manipulation under anaesthetic and arthroscopic capsular releases. However there was only limited evidence to conclude their effectiveness (Favejee, Huisstede, & Koes, 2011, & Lewis 2015).

Physiotherapy typically is involved in the early and later stages of the condition, as it is often able to improve the painfree function in the early stages as well as assist with the diagnosis of the condition.  Once the thawing phase has begun, physiotherapy helps to restore range of motion and strengthening exercises. 

If you are looking for a physiotherapist with an expertise in musculoskeletal physiotherapy, give us a call to see what we can do.  We are a Thornleigh based physiotherapy service, also servingHornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, West Pymble and beyond.