Frozen Shoulder

Frozen shoulder also known as adhesive capsulitis is a condition where the joint capsule becomes inflamed and subsequently thickens and becomes tight. As a result, the shoulder is painful on movement and limits shoulder range of motion actively as well as passively. It mainly affects the female population, age between 40-60 years old. It usually occurs on one side and can get well on its own but it might resolve in 2-3 years or even longer. ^[1]

Who are at a higher risk of getting frozen shoulder: ^[2]

1. People with diabetes
2. Prolonged shoulder immobilization (due to injuries/trauma/surgery)
3. Systemic disease (Thyroid problems/Cardiovascular/Heart issues/ Parkinson’s disease)
4. People who consume antiretroviral medications.

People who have frozen shoulder often pass through 3 phases of symptoms: ^[3]

1. Freezing (painful) phase
   Feeling intense pain, especially at night
   Loses range of motion
   Last from 6 weeks to 3 months
2. Frozen (stiffness) phase
   Painful sensation may reduce
   Stiffness still persist
   Lasts for 4-6 months
3. Thawing phase
   Gradually improving
   Pain lesser; gaining range of motion
   Takes 6 months-2 years

The treatment goal is to reduce the pain and restoring the normal range of motion as soon as possible. It can be treated conservatively and non-conservatively. To control the pain caused by inflammation, therapeutic techniques such as exercise therapy, laser therapy and interferential therapy ^[9] can be used. Patient is advised to consult a medical professional and might need to consume anti-inflammatory drugs to reduce the inflammation as well.

Patient with severe pain or irritability, can go for a steroid injection ^[4] and start with our physiotherapy management in about 2 weeks’ time. However, people with diabetes should be aware of the consequences in choosing this injection method as the injection might increase their blood sugar. Joint mobilisation on the glenohumeral joint helps in reducing pain and improving the shoulder range of motion and function too. ^[5][6]

Stretching and strengthening exercises are the homebased exercises that will be taught to the patient so they can practice it at home. To know more, refer to the following links:

• http://orthoinfo.aaos.org/topic.cfm?topic=a00071 ^[3]
• http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/frozen-shoulder-exercises ^[7]

Scapulothoracic exercises are also important in minimising the pain and increasing the ROM. ^[8]

References:

1. Prestgaard TA. (2016) Patient education: Frozen shoulder (beyond the basics). [Online] Available at: https://www.uptodate.com/contents/frozen-shoulder-beyond-the-basics [Accessed on 14^th March 2017]
2. Wong PLK. and Tan HCA. (2010) A review on frozen shoulder. Singapore Med J. 51(9). 694.
3. Widmer B. (2011) Frozen Shoulder. American Academy of Orthopaedic Surgeons [Online] Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00071. [Accessed on 14^th March 2017]
4. Ryans I. et al. (2005) A randomised controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology Oxford. 44(4). 529-35.
5. Johnson AJ. et al. (2007) The effect on anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Journal of orthopaedics and sport physical therapy. 37(3) 88-99.
6. Vermeulen HM. et al. (2006) Comparison of high grade and low grade mobilization techniques in the management of adhesive capsulitis of shoulder: Randomized controlled trial. Phys Ther. 86(3). 355-68.
7. Sports Injury Clinic. (n.d) Frozen Shoulder Exercises. [Online] Available at: http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/frozen-shoulder-exercises. [Accessed on 14^th March 2017]
8. Celik D. (2010) Comparison of the outcomes of two different exercise programs on frozen shoulder. Arta Orthop Traumatol Turc. 44(4). 285-92.
9. Electrotherapy modalities for adhesive capsulitis (frozen shoulder) http://www.cochrane.org/CD011324/MUSKEL_electrotherapymodalities-for-adhesive-capsulitis-frozen-shoulder

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