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Rear view of a man having his left shoulder examined
Rear view of a man having his left shoulder examined
Anatomincal depiction of a person holding a painful shoulder

by Adam Brown
updated July 17, 2020

Frozen Shoulder (also known as Adhesive Capsulitis) is a chronic condition affecting the shoulder characterized by chronic joint stiffness and pain.    “Frozen” is an appropriate description as the shoulder joint will lose movement in all directions, creating significant disability with activities that require use of that arm.

It can affect up to 5% of the population, with women affected more than men.  It usually occurs after the age of 35 with the peak being in the mid 50s.

Symptoms of Frozen Shoulder

Adhesive capsulitis generally results in pain directly in and around the shoulder joint.  When the condition is more acute, it can occasionally refer pain into the upper arm.  True neurological symptoms are uncommon (tingling, numbness, significant muscle weakness) as is notable swelling or discoloration.

Patients commonly report pain with rapid arm movements, and at night, especially lying of the affected shoulder

There are 3 typical phases of progession

  1. Freezing (3-9 months duration)  Pain is the primary factor limiting movement
  2. Frozen (9-15 months duration)  Movement is significantly limited with pain only at end of range
  3. Thawing (15-24 months duration)  Very little pain.  Movement gradually begins to improve

Causes of Frozen Shoulder

There are 2 types of Adhesive Capsulitis (Primary and Secondary)

1.  Primary – The cause is unknown

2.  Secondary – Occurs as a result of other conditions

  •         Prior shoulder injury (e.g. trauma)
  •         Surgery (e.g. lymph node removal)
  •         Long-term immobilization (e.g. post-surgery, stroke)

In both types of frozen shoulder, the research is unclear as to how the actual condition begins.  One theory suggests that there may be an autoimmune component to the process, where the body attacks healthy tissue spiralling into a growing inflammatory response.

Diagnosing Adhesive Capsulitis

Diagnostic Tests

X-rays, ultrasounds etc are only useful in ruling out other conditions (e.g calcifications,   rotator cuff tears).  It is not used to diagnose adhesive capsulitis.

Clinical Exam

The most common and accurate method of diagnosing adhesive capsulitis is through a thorough history and objective physical examination by a physiotherapy or similarly qualified medical professional.  One of the key findings will note the unique feature of active shoulder range of motion equaling passive range of motion.

Treatment for Frozen Shoulder

  • Anti-inflammatory medications
  • Injections of corticosteroid or anaesthetics
  • Manipulation of the shoulder under anesthetic
  • Arthroscopic surgery to release the shoulder joint capsule
  • Physiotherapy (exercises, mobilizations, stretching, activity advice)

Prognosis and Outcomes

80% of affected individuals will recover without surgical or aggressive treatment.  However though physiotherapy and other interventions can improve symptoms, recovery is generally prolonged and can last from 9 months to 2 years.  20-30% will develop frozen shoulder in the opposite arm, typically within a few years of the first occurrence.  Recovery is slower in patients whose dominant arm is affected, work in manual labor jobs, or are older.

Frozen shoulder or Adhesive Capsulitis is a common condition seen among shoulder pain patients in our physiotherapy clinic.  Please contact us if you have any specific questions about physiotherapy treatment for this problem.


Adam Brown

Adam Brown        MClScPT
Registered Physiotherapist

Adam is a highly experienced physiotherapist, successfully treating patients with a variety of complex shoulder injuries since graduating in 2002. He is a co-founder of the well-regarded Cornerstone Physiotherapy Clinics with locations through the Greater Toronto Area. He enjoys mentoring and educating orthopaedic physiotherapists and contributing to rehabilitation research studies.

 

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