Frozen Shoulder

Frozen Shoulder has no specific definition or cause. It can be primary (idiopathic) or secondary (T2DM, CV disease, hemiparesis, trauma or TB). It is also known as adhesive capsulitis, painful stiff shoulder, retractile capsulitis and monoarticular arthritis.

Symptoms

• Pain felt near deltoid insertion
• Inability to sleep on affected side
• Painful and incomplete elevation and ER
• No primary diagnostic test; AROM=PROM
• Mistakable for bicipital tendonitis or impingement
• Standard tests (e.g. Neers) positive during the painful phase as they stretch the joint capsule
• ER most restricted, abduction, less, IR less still (Cyriax, 1982) although arthritis and fractures could cause a similar capsular pattern
• Negative x-rays

Progression

• Stage One - 'Freezing Stage'
• Progressive stiffening
• Loss of ROM
• Increasing pain on mvt
• 2-9 months
• Stage Two - 'Frozen Stage'
• Gradual decrease in pain, stiffness remains
• Considerable loss of ROM
• 4-12 months
• Stage Three - 'Thawing Stage'
• Improvement in ROM
• 12-42 months

Treatment

• Conservative Treatment
• Medication
• NSAIDS, opiods
• Physio
• Advice and education
• Superficial heat or cold therapy
• Electrotherapy
• Exercise and mobilisation
• Minimally Invasive Treatment
• Injections
• Hydrodilation
• Corticosteroids
• Sodium hyaluronate
• Acupuncture
• Invasive Treatment
• Arthroscopic capsular release
• Manipulation under anaesthetic

Physiotherapy Treatment - Stage III

• Home Exercise Programme
• ROM and strengthening
• Progress from static to dynamic strengthening
• Shoulde retraction and rolls
• Pendular mvts in forward leaning
• Mobilisation
• End range and mobilisations with movement more effective than mid-range mobilisation (Yang et al, 2007)
• Shoulder classes
• Long-term
• Education
• Up to 17% of patients experience frozen shoulder in their other arm within 5 years