What is it?
Adhesive capsulitis or what is commonly referred to as frozen shoulder is a condition where a person experiences a significant amount of pain and decreased range of motion of their shoulder over a gradual period of time. This condition can be highly debilitating rendering a person’s shoulder nonfunctional. Approximately 2-5% of the population will develop frozen shoulder. Usually x-rays are negative and a person is diagnosed after a thorough history and physical examination.
As of now the etiology is still under debate. Some research shows that chronic inflammation of the shoulder can cause the shoulder joint to become tight which leads to pain and limited range of motion. Other research has shown that inflammation does not always play a role and is instead caused other factors such as genetics. Furthermore, some research has even suggested that frozen shoulder is caused by an accumulation of other factors including blunt trauma or repetitive trauma to the shoulder joint.
Although the exact cause of frozen shoulder is still under debate there are risk factors that make a person more likely to develop frozen shoulder. Women are more likely to develop frozen shoulder than men. Also, the onset usually occurs between the ages of 40-70. In addition, people who have diabetes are at a larger risk to develop frozen shoulder. Lastly, people who have sustained trauma, have arthritis of the shoulder or have had their shoulder immobilized for an extended period of time are at greater risk.
The overall prognosis is favorable. The vast majority of patients’ symptoms will resolve. The majority of people who suffer with frozen shoulder will regain approximately 95% of their shoulder range of motion.
Stages and Physical Therapy
Frozen shoulder syndrome often demonstrates a typical progression that is broken down into three main stages. The first stage of frozen shoulder is usually marked by more severe pain and mild loss in range of motion of the shoulder. This typically occurs in the beginning weeks after the initial diagnosis and progresses through time. This stage is often referred to as the freezing stage. A person may notice that they are unable, sleep on their side, put their arm behind their back or put on a jacket.
The next stage is usually referred to as the frozen stage. The stage usually occurs between 4-12 months after the initial onset and the largest impairment is no longer pain, but rather significant decrease in range of motion of the shoulder. At this stage a person may not be able to elevate the hand above their shoulder or bring their hand out towards the side.
The last stage is referred to the thawing stage. This usually occurs between 5-24 months after the initial diagnosis. This stage is demonstrated by a decrease in pain levels and a marked, but slight increase in range of motion of the shoulder. This stage is where aggressive physical therapy has been shown to be the most successful. Physical therapy treatment will include heat and ultrasound to help loosen up the shoulder joint. Also, electric stimulation may be used to help reduce pain levels. To restore range of motion a physical therapist will use techniques to place the shoulder joint in end rage positions. In addition, a physical therapist will stretch the muscles that surround the shoulder joint and the shoulder blade. As range of motion of the shoulder returns a physical therapist will also provide exercises that help strengthen the rotator cuff and the muscles that surround the shoulder blade. A detailed list of exercises will be given to a patient to perform at home. This helps maintain any gains that occurred during therapy. It’s important to remember that the overall prognosis for this condition is largely favorably, and the majority of cases resolve over a period of time (12-42 months), but with physical therapy this process can be greatly accelerated. For more information on physical therapy services visit www.totalperformancept.com.
If you are having difficulty with a stiff or painful shoulder don’t delay, make appointment at Total Performance Physical Therapy.