Frozen Shoulder



What is Frozen Shoulder

Frozen shoulder is a condition where there is a loss of range in motion in external rotation, abduction and then internal rotation at the arm. 

It is characterized by a gradual onset of pain and limitation in range. 

*External rotation = the movement done to reach behind you in the car 

*Abduction = the movement done during jumping jacks or to reach for something above your head from the side 

*Internal rotation: putting on a belt buckle when facing forward 


Causes

The condition has a range of possible causes, such as arthritis, tendon inflammation, shoulder injuries, genetic or environmental factors. The inflammation can lead to adhesions and stiffness. Some other causes include surgical events, predisposing factors, such as postures and daily activities.  Some are idiopathic causes (there is no exact cause).


Stages of Frozen Shoulder

Freezing Stage: Gradual onset of pain, especially in extremes of range, with pain at night, lasts 2-9 months 

Frozen Stage: Pain subsides but loss of motion in shoulder, pain at extremes, lasts 4-12 months 

Thawing Phase: Spontaneous, progressive improvement in range. 

The entire condition can last 2-3 years, however some studies show 15% of people have persistent pain and long term disability 


What Can I Do About It? 

TALK TO YOUR PHYSIOTHERAPIST! 

Definitive treatment remains unclear but multiple interventions have been studied. "Enrolling in a physical therapy program is the key to recovery" . (Mezian & Chang, 2019) 

Proprioceptive neuromuscular facilitation (PNF) has also been shown to decrease pain, increase range of motion, improve function and reduce disability. (Tedla & Sangadala, 2019)

During the freezing safe, gentle mobilization, muscle release, acupuncture and taping can help with pain relief. Application of TENS and pain free exercises have also been helpful at reducing pain. (DONER, G. GUVEN, Z. ATALAY, A. & CEL I KER, R. 2019) 

During the frozen stage, mobilization with movement, acupuncture, stretches, muscle release and strengthening are effective. ( KEL LEY, M. MCCLURE, P. & LEGGIN, B. 2009) 

During the thawing stage, stretch frequency and duration, along with strengthening are highly indicated. Use of a pulley to increase the intensity of exercises is also beneficial during tissue remodeling.



References 

Adhesive Capsulitis. (2021, January 19). Physiopedia, . Retrieved 17:59, April 13, 2021 from https://www.physiopedia.com/index.php?title=Adhesive_Capsulitis&oldid=265282. 

Kelley M, Mcclure P, Leggin B. Frozen shoulder: Evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39:135-148. 

Mezian K, Chang KV. Frozen Shoulder. InStatPearls [Internet] 2019 Feb 25. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/ (last accessed 25.11.2019) 

Tedla JS, Sangadala DR. Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: a systematic review and meta-analysis. Journal of musculoskeletal & neuronal interactions. 2019 Dec 1;19(4):482-91

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