Frozen shoulder or Adhesive Capsulitis is a common condition that we treat at Total Physiotherapy. It is commonly seen after significant trauma, following an injury to the nerves around the shoulder and neck, or it may occur spontaneously.
Frozen shoulder is often classified into two different categories; 1) primary which is spontaneous and referred to as Idiopathic Adhesive capsulitis. This commonly affects the left shoulder and is more common in women than men. 2) Secondary, which is due to trauma or subsequent immobilisation. Primary adhesive capsuilitis is generally gradual onset and there is no known incident that may have caused the stiffness or pain. It is also more common in patients who are between the ages of 40 and 60 and who also suffer from diabetes and thyroid problems. Secondary adhesive caspulitis commonly occurs after a falls or trauma to the shoulder that may cause pain and loss in movement.
The cause of adhesive capsulitis is up for debate with a number of different theories, and it is rare that the condition needs surgical treatment.
Adhesive capsulitis is commonly split into three different stages;
- The first stage is referred to as the ‘Freezing’ or ‘Painful Stage’. It is characterised by increased pain which restricts movement and often results in the individual seeking medical advice. This phase typically lasts between 3 and 9 months.
- The ‘Frozen’ or ‘Painful Stage’ is the next stage. This stage typically lasts for between 4 and 12 months and is characterised by poor range of movement and loss of use in the arm because of muscular disuse.
- The last stage being the ‘Thawing Phase’. This generally lasts between 12 and 24 months and is characterised as a gradual return in movement at the shoulder joint.
The stages are a continuum with each stage merging into the next, there is not a definite transition into each phase. This will happen gradually and the time spent in each phase will depend on the severity of symptoms, the patient’s medical history, the extent of previous trauma (if any) and the treatment they receive.
How does physiotherapy help with a Frozen Shoulder?
When suffering with adhesive capsulitis it is extremely important to maintain mobility as best possible as prolonged immobilisation has proven to cause reduced collagen length, a reduction of ligament tissue, random collagen production with bridging across recesses, as well as reduced muscle length.
At Total Physiotherapy we will complete a thorough shoulder assessment, aiming to determine where the shoulder is painful and if there is a definite cause. Frozen shoulder can often be confused with other shoulder conditions such as trauma, rotator cuff tear, rotator cuff rupture, labral tear, subacromial bursitis, cervical or thoracic neuropathy.
At Total Physiotherapy we aim to treat the condition in relation to the patient’s symptoms and maintain mobility where best possible. One clinical study showed that through using heat therapy, TENS and by prescribing shoulder mobility exercises in stage 2 of the condition significantly improved pain. It also showed that through using Muscle Energy Techniques (MET’s) there was also a significant reduction in pain at stage 2 of the condition. It is therefore clear that using these modalities in the painful stage of the condition can reduce pain and allow the patient to gain more movement at the shoulder and progress sooner in to the thawing stage.
If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.