Frozen Shoulder / Adhesive Capsulitis

Glenohumeral Joint

• shoulder girdle (upper arm, shoulder blade or 'scapula', and collarbone) is most mobile 'functional unit' in body; comprised of a number of articulations (joints) including glenohumeral (scapula-upper arm), scapulothoracic (scapula-rib cage), acromioclavicular (scapula-collarbone), sternoclavicular (sternum-collarbone), spinal articulations with ribs and of neck and upper back
• all articulations of shoulder functional unit must be able to move and do so in a coordinated manner to permit full dynamic range of motion of arm
• glenohumeral joint enveloped in a flexible, folded capsule which unfolds and stretches to permit significant multidirectional range of arm; also, inner lining of capsule exudes lubricating (synovial) fluid into joint

Frozen Shoulder/Adhesive Capsulitis

• unknown cause: 'spontaneous or insidious onset' gradual evolution of condition with no known provocation; possible autoimmune system dysfunction or end result of guarding or protecting of painful, post-traumatic shoulder (classic case of "use it or lose it ")
• afflicts primarily those over 40 years of age
• flexibility of elastic capsule lost as joint capsule invaded with fibrous tissue; joint lubricating fluid diminishes
• recognizable pattern of signs and symptoms occurs gradually
• early intervention with therapeutic modalities, joint mobilization, stretching, and core strengthening can alleviate symptoms and limit or reverse disabling progression
• unfortunately, patient typically presents for treatment after symptoms and dysfunction have been present, and increasing, over several weeks (presuming, until then, that shoulder restriction and pain would soon pass)
• conditioning and functional retraining activities assigned
• response to direct intervention assessed over four to six initial treatment sessions; subsequent scheduled attendances for treatment individualized according to observed evolution of condition for optimal outcome results

Other Treatments

• analgesic (pain) and/or anti inflammatory medication may be prescribed by physician
• application of heat or ice for pain relief and, thereby, to facilitate movement through range

Prognosis

• condition is self-limiting and will, ultimately, resolve even without treatment
• condition tends to be persistent and, without treatment, may take one year (occasionally two) before pain abates and full range of motion regained
• diabetics may experience relatively delayed recovery
• condition may, within a few years, occur in shoulder of opposite side

Physio Note: Use of Heat or Ice

Heat is useful prior to exercise as muscles and tendons are generally more flexible when warm.

If pain increases with activity, apply ice to shoulder at end of exercise session