Managing Frozen Shoulder

Adhesive capsulitis (AC) also known as frozen shoulder, is a condition, affecting 2-5% of the population that causes fibrosis and stiffening of structures inside the shoulder joint. AC typically affects the coracohumeral ligament first, resulting in limitations with external rotation of the arm. In advanced stages, thickening and contraction of the glenohumeral joint capsule develop, limiting shoulder range of motion in all directions. This can be extremely debilitating, interfering with activities of daily living, work, and leisure activities. As aetiology of the condition is poorly understood there is many factors that could contribute to the development of AC such as trauma/surgery, Diabetes, cardiovascular disorders, thyroid disorders, neurological disorders, cancers and certain medications. There are currently no specific diagnostic tests, with the diagnosis of AC made through reviewing medical history, imaging modalities and physical examinations. The average length of rehabilitation of someone with AC is between 18-24 months with most affected individual’s being able to regain full motion and function in the long term.

 

There is no consensus of gold standard treatment for AC. In most cases, treatment options begin with conservative treatment such as exercise therapy. Exercise has been proven to assist with reducing shoulder pain, increasing shoulder range of movement and increasing shoulder function in those affected by AC. I am currently assisting a patient who is in the “freezing” phase of AC. Her pain and inflammation are severe and varies dramatically from week to week. We are currently alternating between hydrotherapy-based exercises to increase range of movement of the shoulder, neck, elbow and hand as these have also been affected, and land-based exercises for when she is unable to physically put on swimwear or when her inflammation is reduced, we are able to produce more movement within the joint. In the early stages, it is important to consider different rehabilitation modes to manage inflammation and ensure the shoulder joint is being used in different planes, movements and against different resistances to slow the progression of the stiffness.

 

Another patient I am seeing with the same pathology, is in the “thawing” stage. As he presents with no pain or inflammation, we have been able to restore his range of movement through high repetition range of movement exercises. We have now progressed to strengthening the joint with theraband and weighted exercises with a focus on correct muscle recruitment through the shoulder and reducing activation of muscles through the upper back and neck, as these had been activating to compensate for the lack of range and strength in the shoulder. Given the chronic nature of this condition, expert advice can help with maintaining low level inflammation while increasing movement and strength gains.

 

Managing Early Frozen Shoulder

  • 0-3 Months: Pre-adhesive Stage: The patient can present with mild or no pain or limitation at end range of movement. The treatment goal in this early phase is to manage the cycle of inflammation.
  • 2-9 Months: “Freezing”: This phase is characterised by shoulder pain that is worse at night, with gradually increased glenohumeral joint range of movement restriction. The aim of treatment in the “freezing” stage should focus on pain control, reduction of inflammation and patient education. Exercise management should be completed daily to slow down movement restriction.

 

Managing Developed Frozen Shoulder

  • 4-12 Months: “Frozen”: This stage is characterised by stiffness and persisted glenohumeral 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.
  • 12-24 Months:Thawing”. This is the recovery phase with the gradual return of range of motion. Treatment objectives in the advanced stages should focus on maintaining shoulder range of movement and function and also include exercises to restore normal glenohumeral biomechanics. If the patient is not responding well to conservative treatments, a more invasive therapy should be considered.

 

The Exercise Physiologists at Absolute Balance design individualised programmes to assist those experiencing the effects of AC. If you are suffering shoulder pain, book an initial assessment with an exercise physiologist at info@absolutebalance.com.au.

Tayla O’Halloran
(B.Sc. Exercise Physiology)
Accredited Exercise Physiologist (AEP) (ESSAM)

 

 

Jain, T.K., & Sharma, N.K. (2014). The Effectiveness of Physiotherapeutic Interventions in Treatment of Frozen Shoulder/Adhesive Capsulitis: A Systematic Review. Journal of Back and Musculoskeletal Rehabilitation, 27(3), 247-273.