Frozen Shoulder/Adhesive Capsulitis

    Frozen shoulder is diagnosed in the United States about 200,000 times per year.  It is characterized by insidious shoulder stiffness and nearly a complete loss of passive range of motion and active range of motion for external rotation.  There are several risk factors which predispose someone to frozen shoulder.  

Diabetes : 20% will develop frozen shoulder.

Age and Gender :  Middle aged women are 40-60 % at risk.

Trauma :  Peolple with a history of injury or surgery.

Auto Immune diorders and Thyroid issues :  Rheumatoid arthritis, lupus, inflammatory bowel disease, Multiple Sclerosis and Psoriasis. 

Signs and symptoms begin gradually and get worse over time.  Adhesive capsulitis usually resolves in 1-2 years.  Frozen shoulder occours when the shoulder capsule thickens and tightens restricting its movement.

Frozen shoulder developes slowly over three stages.  Each stage can last several months.

freezing stage :  Increased pain, inflammation in the joint and decreased range of motion.  3 to 8 months 

Frozen stage :  High scar tissue, significant decrease in range of motion. 4 months to 1 year.

final stage/thawing : Regain range of motion and a decrease in pain.  4 months to 2 years.

Treatment should include decreasing the pain and increasing range of motion in the shoulder complex.  Corticosteriod injections by a physician, ice,  TENS, and anti-inflammatory drugs are appropriate in the acute phase.  The patient should avoid overhead reaching,lifting,or anything that increases pain during the initial stage.  90% of people diagnosed with frozen shoulder improve with physical therapy and or non surgical methods.

Exercises

  All exercises should focus on resuming range of motion and decreasing pain.

• Pendulum Exercises
• Towel Stretch
• Finger walk/Finger board
• Cross body reach
• Pulley Exercises

   Joint mobilizations and passive range of motion should also be incorporated into treatment plan.  Small amplitude joint mobilizations should be used in available range of motion in the beginning.

• Grade 1.  Small amplitude in available ROM.  Helps decrease pain.
• Grade 2.  Large amplitude through middle range of motion.
• Grade 3.  Large amplitude movement performed from middle to limit of the range of motion.
• Grade 4.  Small amplitude movement at end ROM
• Grade 5.  Small amplitude manipulative movement performed beyond end ROM.  Requires advanced training.

   Scapular mobilization techniques should also be used when treating patients with frozen shoulder.  Studies have shown patients with frozen shoulder demonstrate a decrease in scapular movements.  Then gleno-humeral joint and scapular thoracic joint should be addressed using various techniques.  Controlling pain with various modalities and patient education are also important aspects of the tretment plan.  Home exercise plan should include ROM and stabilization exercises of the  entire shoulder complex which includes the GHJ, Acromioclavicular joint, sternoclavicular joint, and scapular-thoracic joint.