Frozen Shoulder…How do I warm it up?!

“How do I WARM IT UP?”

The exact cause of Frozen shoulder, or as it is formally known as, ADHESIVE CAPSULITIS, remains unclear. It is believed to be secondary to the formation of adhesions in the joint capsule or capsular contraction that results in pain and inhibition of movement through the shoulder(1).

The reason many refer Adhesive Capsulitis as “frozen shoulder” is due to the presentation of the symptoms. There is an insidious onset of pain through the glenohumeral (shoulder) joint, followed by a gradual reduction in the range of motion and movement, ultimately resulting in severe stiffness through this joint(4). Many people report that this process feels like their shoulder is “freezing and then becomes frozen”.

Consequently, this can interfere quite significantly to people’s activities of daily living as it extremely limits or even inhibits the use of the affected shoulder. This is especially true with overhead activities, such as hanging up the washing, or pulling on a jumper.

Although the exact cause and etiology of frozen shoulder remains unclear, there have been multiple risk factors identified that are associated with this condition(4).

• >50 years of age

• Early menopause or post-menopausal

• Diabetic disorder

• Hypothyroidism

• History of shoulder trauma or surgery

Frozen shoulder reduces the area of the shoulder joint capsule and thickens it five-fold.

Although there is no clear physiological boundary of phases that identify the different presentations of adhesive capsulitis, It is common to distinguish some of the key features into the ‘3’ Phases of Frozen Shoulder:

1. FREEZING(4)

• Shoulder PAIN is the primary complaint

• Including Night pain

• Pain inhibits full shoulder range of motion (in the capsular pattern)

• A swollen shoulder capsule

• No loss of strength or stability

• Lasts approximately three months

2. FROZEN(4)

• Shoulder STIFFNESS is the primary complaint

• Shoulder capsule has contracted

• Reduction in the pain severity

• Global loss of shoulder movement

• Lasts approximately 4-12 months

3. THAWING(4)

• Shoulder stiffness gradually subsides

• A graded return to shoulder range of movements (in the reverse capsular pattern)

• Can take up to 2 years in duration

Therapy for Frozen Shoulder

Treatment options

Do I Jab it, or Rehab it?

There is a range of treatment options offered for this condition; however, two of the most commonly utilised interventions are:

1. CONSERVATIVE MANAGEMENT:
   This form of treatment is multifactorial and involves patient education, stretching exercises, range of motion exercises and mobilisations(2). Early intervention is shown to reduce the natural history and severity of Frozen shoulder(2). Conservative management varies depending on the current stage of the condition.

2. CORTICOSTEROID INJECTIONS (CSI):
   CSI in the early stages of phase 1 is key to reducing the natural history and severity of Frozen shoulder(3) as it limits the development of the adhesions within the capsule and reduces local inflammation(3). The intra-articular CSI can work well in conjunction with appropriate conservative management(3).

Simple Steps to a Safe & Speedy Recovery

Freezing phase 1:

• Avoid aggravating activities (1)

• Focus on pain relief modalities (e.g. heat, NSAIDS)(2)

• Pendulum Exercises: Gentle range of motion exercises (low intensity and duration) and very gentle stretches(2)

• Seek advice from a healthcare professional including that of potential corticosteroid injection (2)

Frozen phase 2:

• More aggressive mobilisations with movement and stretches (as tolerated by the patient)

• Low load stretches with increased duration)(1)

• Attempt to resume function and improve range of motion(1)

• Soft tissue (as tolerated) to the adjacent and local musculature

Thawing phase 3:

• Promote the progression of natural history by actively partaking in active and passive range of motion exercises

If you or anyone you know suffer from adhesive capsulitis, it is best to see your local practitioner. ‘

---

Dr Grace Cumming

Chiropractic Associate

References:

1. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331(7530):1453-1456.

2. Kelley M, Mcclure P, Leggin B. Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(2):135-148.

3. Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation. 2008;22(6):503-512.

4. Walmsley S, Rivett D, Osmotherly P. Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique. Physical Therapy. 2009;89(9):906-917.