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Adhesive Capsulitis / Frozen Shoulder Syndrome

Background and Etiology (cause)

Adhesive Capsulitis (commonly referred to as Frozen Shoulder) is an inflammatory condition of the shoulder. It occurs most often in females between 40-60 years old. This condition is characterized by pain, loss of function, tightness and decreased shoulder motion (the characteristic “frozen” feeling).

What happens when your shoulder “freezes?”

The joint capsule is a sleeve of connective tissue that supports and helps provide stability to the shoulder joint. When the capsule becomes inflamed it constricts, becoming very tight, limiting range of motion and causing pain. As the capsule shortens and the ability to move is lost, other soft tissue, like muscles, can also shorten and restrict shoulder movement. A cycle of pain, soft tissue tightening and loss of motion develops.

Cause

Adhesive capsulitis is often triggered by other inflammatory conditions like bursitis, tendonitis or shoulder impingement. Other high risk activities or conditions that can lead to the development of adhesive capsulitis include:

  • Participating in activities like swimming, or activities with repetitive overhead movements like tennis, softball, or baseball may aggravate the shoulder.
  • Overhead repetitive strain or overuse
  • A sudden fall on the shoulder
  • Though infrequent, frozen shoulder may develop during post surgical shoulder rehabilitation, (including shoulder joint replacements, open and arthroscopic procedures) if the normal range of motion is not regained within a reasonable time frame.
  • Patients who have a history of diabetes or uncontrolled blood sugar levels may develop a special type of frozen shoulder called Diabetic Shoulder).

Signs and Symptoms

  • Shoulder pain that can radiate to the upper arm
  • Moderate to severe loss of shoulder motion, especially the ability to reach overhead and behind the back. This loss of motion may be minimal at first, but can gradually develop to a significant loss of shoulder movement.
  • Difficulty dressing and performing activities of daily living (ADL’s)
  • Pain when sleeping
  • Feeling of tightness in the shoulder joint pain and muscle weakness may develop along with loss of motion

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goals of the patient or client. Common interventions in the treatment of Adhesive Capsulitis include:

  • Manual Therapeutic Technique (MTT): hands on care by a physical therapist to regain mobility and range of motion of the shoulder and surrounding joints.
  • Therapeutic Exercise (TE) to restore range of motion and strengthen the shoulder and surrounding joints.
  • Neuromuscular Reeducation (NMR) to begin retraining the upper extremity and the patient overall to use the involved upper extremity in daily activities.
  • Modalities including the use of ultrasound, electrical stimulation, cold laser and others to decrease pain at the shoulder.
  • Home programs, including exercises and instructions to help the patient perform daily tasks and advance to the next functional level

Medical Interventions

Procedures a physician may recommend and perform in addition to physical therapy.

  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce discomfort and allow the patient to perform the recommended exercises
  • Manipulation or passive movement of the restricted shoulder joint under anesthesia to improve motion, break up scar tissue, adhesions and restore function. This is very rare but occasionally necessary.
  • Surgery to correct underlying pathology or the cause of the frozen shoulder.

Prognosis

According to The Guide to Physical Therapist Practice, adhesive capsulitis is included within a practice pattern that states that the pain and loss of function is associated with connective tissue dysfunction. The prognosis for a diagnosis within this practice pattern is that the condition will require between two weeks to six months of physical therapy direct intervention, dependent on the initial severity of symptoms.