Frozen Shoulder is painful and ridiculous.
Why does it take so long to recover?
Why is it getting worse?
I've tried everything to kill the pain, I feel so weak now, life doesn't stop because of my shoulder issue.
Frozen shoulder or adhesive capsulitis presents with spontaneous onset of pain and stiffness in the shoulder joint.
In the above image you can see the hardening of the soft tissue structure which surrounds the shoulder joint. This hardening is very much similar to Dupuytren's disease of the hand where the 4th and 5th fingers remain in a fixed flexed position. See below.
Frozen shoulder tends to have a higher incidence amongst women, affecting the left shoulder more than the right and with an average age of onset of 40-60 years.
Certain risk factors can increase the likelihood of Frozen Shoulder developing. Such as having diabetes, a previous improperly managed shoulder injury or a history of cardiac/shoulder surgery such as rotator cuff tears.
Although 50% of cases have no known cause/reason for developing Frozen Shoulder. That's seriously ridiculous.
The vast majority of cases should resolve within an average timeframe of 3-4 years.
Frozen shoulder and physio will progress through 4 stages.
STAGE 1
Initially stage 1 presents with severe pain which increases in intensity till it reaches a peak pain level, worse at night. Flexibility is very limited. This process lasts about 3 months.
Treatment focuses on pain management at stage 1. Physiotherapy treatments include manual therapy, exercise prescription and modification of activities. Pharmacological options include use of anti-inflammatory medications.
STAGE 2
Stage 2 is characterised by a reduction of pain, and some freeing up of movement. There is pain though with movement to the end point of range. This stage takes about 6 months to resolve.
Treatment focuses on pain management and starting restoration of movement. Evidence based research has shown joint mobilisation/manual therapy as effective in increasing the movement ability of the shoulder. When combined with a targeted exercise program, a quicker recovery of function can occur.
STAGE 3
Stage 3 (6 months to resolve) involves no/minimal pain in the shoulder with only stiffness towards end range movement. Physiotherapy treatment involves restoring as much movement as possible through manual therapy and exercise management.
There are other invasive procedures that can be used at this stage too, including corticosteroid injections and hydrodilation. In addition operative procedures including manipulation under general anaesthesia. These procedures are best discussed with your treatment providers as there are times when they may be indicated.
STAGE 4
Stage 4 (1-2 years to resolve) involves resolution of Frozen Shoulder with return to normal function.
Don't forget about strengthening up your shoulder....
Even 2 weeks of limited shoulder use will cause muscle wasting, it takes even longer to build up to your pre-injury function. Management requires appropriate strength based exercises to restore your function.
Be aware of compensatory strategies that your body may use in the meantime, whilst recovering from Frozen Shoulder. Due to limited function of the shoulder, excess pressure could be placed on the joints above and below the shoulder.
All of a sudden your Frozen Shoulder may not be the only musculoskeletal issue that you have to deal with.
Frontline Family Physio will guide you along with confidence.
Sean Hua, APAM
Director and Physiotherapist.
Shop 6/2a Brown St
Ashfield NSW 2131
References:
›Cavelleri, E., Servadio, A., Berardi, A., Tofani, M., & Galeroto, G. (2020). The effectiveness of physiotherapy in idiopathic primary frozen shoulder: A systematic review and meta-analysis. Muscles, kigaments and tendons Journal.10(1): 24-39. Doi: 10.32098/mltj.01.2020.04
›Favejee, M., Huistede, B., Koes, B. (2010). Frozen soulder: The effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 45:49-56. Doi: 10/1136/bjsm.2010.071431
›Tedla, J., & Sangadala, D. (2019). Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: A systematic review and meta-analysis. Journal of musculoskeletal and neuronal interactions. 19(4), 482-491.
Comments