subject: About Frozen Shoulder And The Ways To Treat It [print this page] A frozen shoulder may develop in some people after an injury near the joint such as a fracture. However others can point to no specific cause. Frozen shoulder may also be associated with another condition such as diabetes, rotator cuff injury, stroke or heart disease, which may prolong recovery and limit outcomes.1 Chronic illness management and rehabilitation can help in these cases.
Scientific investigation has found that the problem is most often the capsule of the shoulder joint. This lose bag of connective tissue surrounding the joint can become inflamed, thickened and contracted giving rise to the conditions technical name, Adhesive Capsulitis (AC).2
Patients with AC complain of shoulder pain, stiffness, and limited function which adversely affects the use of the whole arm. While the majority of frozen shoulder patients are women, men with frozen shoulder are at greater risk for prolonged recovery and greater disability4-5.
Usually frozen shoulder goes through 3 stages: painful stage, stiffness or frozen stage, and recovery or thawing stage, with the average length of symptoms lasting 30 months.6 While the stiffness stage is the longest of the stages, AC is thought to be reversible in the acute pain stage.7
Physiotherapy has been proven to be helpful in improving range of motion and pain in frozen shoulder. 8,9
Therapeutic Exercise. Probably the most commonly prescribed therapeutic exercises for FS are active or assisted range of motion exercises. These typically involve the patient using the uninvolved arm, or using equipment such as rope-and-pulley, wand/T-bar, or exercise balls. This type of treatment has been found to be successful in 90% of FS patients when done at least twice per day.5 Resistive exercises is often added by the physiotherapist to the patients exercise program when range of motion has progressed enough.
Passive Motion and Manual Techniques. Because frozen shoulder involves tightening of shoulder connective tissue structures, stretching is commonly used. This may include continuous passive motion or dynamic splinting. Several studies have demonstrated the effectiveness of joint mobilization in adhesive capsulitis patients.14,15
Modalities. Physiotherapists use a variety of physical treatments to improve on the effects of exercise. Shortwave diathermy can be used to heat the capsule of the shoulder making it more elastic before stretching to improve range of motion. 31 Low-power laser therapy or Transcutaneous Nerve Stimulation (TENS) may be helpful in reducing pain allowing patients to exercise more effectively.11,12,13
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idiopathic adhesive capsulitis. J Bone Joint Surg Am.2002;84-A:1167-1173
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the shoulder. J Bone Joint Surg 1945;27:211-222.
3. Boyle-Walker, K. L., Gabard, D. L., Bietsch, E.,Masek-VanArsdale, D. M. & Robinson, B. L. A profile
of patients with adhesive capsulitis. J Hand Ther1997;10:222-228.
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6. Reeves, B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193-196.
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physical therapy and follow-up shoulder arthrography. Arch Phys Med Rehabil. 1997;78:857-859.
8. Jurgel, J. et al. Shoulder function in patients with frozen shoulder before and after 4-week
10. Jewell, D. V., Riddle, D. L. & Thacker, L. R. Interventions associated with an increased or
decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a
retrospective cohort study. Phys Ther. 2009;89:
11. 419-429.28. Rizk, T. E., Christopher, R. P., Pinals, R. S., Higgins,A. C. & Frix, R. Adhesive capsulitis (frozen shoulder): a new approach to its management. Arch Phys Med Rehabil. 1983;64:29-33.
12. Green, S., Buchbinder, R. & Hetrick, S. Physiotherapy interventions for shoulder pain.
