Frozen Shoulder – A Case Study

Adhesive capsulitis (AC), often referred to as a frozen shoulder is categorized by initially painful and later progressively limited active and passive shoulder joint range of motion with spontaneous complete or near-complete recovery over a long period of time. The condition is frequently defined as a loss of more than 25% of the normal shoulder range of motion in at least two directions.

Frozen shoulder can develop after a shoulder has been immobilized for a period, due to surgery, a fracture, or another injury. Moving the shoulders safely, soon after injury or surgery is one way to prevent a frozen shoulder.

I have recently been seeing a patient that developed adhesive capsulitis after a period of inactivity following surgery.

Client Background

  • 60-year-old Male
  • Works as a Sign Maker – Job involves repetitive upper limb use up to 20kgs.
  • Required a rotator cuff repair in November 2018 after sustaining an injury at work.
  • Diagnosed with adhesive capsulitis in May 2019.
  • During the initial assessment, he demonstrated restrictions when performing shoulder abduction and flexion with a 50% limit in the range of motion when compared to his right side. He also described pain scores during shoulder abduction and flexion at a 5 out of 10 on the universal pain scale at the end range of these movements and stated that his pain levels are at a constant 3 out of 10 during his daily activities.
  • Lived an active outdoor lifestyle before the injury – At the initial assessment he believed it will be 18 to 24 months until he gets back to this

There are three main phases of frozen shoulder; Freezing, Frozen, and Thawing. When I saw this patient, they were within the Frozen phase. This is described below,

 “Frozen”: This stage is characterised by stiffness and persistent joint motion limitation, but with less pain than that at the “Freezing” stage. As inflammation during this stage has decreased, a more aggressive approach to exercise therapy should be considered to restore normal range of motion and shoulder function.

The exercise programme initially began with hydrotherapy exercises and quickly moved to a gym-based exercise programme. The patient also had several home-based exercises to complete with pulleys and resistance bands and was completing both the gym programme and home exercises a minimum of 5 times a week.

As of the last supervised session the patient has regained 90% of movement through the shoulder, with pain levels down to a 1/10 on the universal pain scale. They have been able to progress from exercises such as a simple incline push up, to a fit ball rollout into a bodyweight push up. He is now completing full preinjury hours and 90% of their normal work duties. They have also made plans to reengage with their outdoor activities when the next season rolls around!

If you would like more information on managing your frozen shoulder or any other specific exercise advice contact Absolute Balance by mail info@absolutebalance.com.au or view our website www.absolutebalance.com.au

Michael Buswell (B.Sc. –  Exercise Physiology)
Accredited Exercise Physiologist (AEP) (ESSAM)

 

Cleland J, Durall C, 2002, Physical therapy for adhesive capsulitis: A systematic review, Physiotherapy August 2002Volume 88, Issue 8, Pages 450–457.

Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar;103(1):40–47.