Frozen Shoulder

Pathophysiology

Also known as Adhesive Capsulitis. Commonly affects those between 50-60 years of age, females more than males and a higher risk in diabetics. Often without injury, but of gradual onset with increasing loss of movement or after trauma due to then being less mobile.

There are 3 stages:

  1. Freezing Stage- painful stage with loss of active (moving the shoulder yourself) and passive (someone else moving your shoulder) movement, pain often worse at night. Generally lasts 3-9 months.
  2. Frozen Stage- pain levels often settle but movement loss can progress further, unable to perform movements such as reaching your hand behind your back, reaching forwards or sideways. Generally lasts 4-12 months.
  3. Thawing Stage- movement begins to return and symptoms improve. Generally lasts 12-42 months.

Symptoms

  • Gradual onset of shoulder pain which may radiate down the arm to the elbow with reduction in movement (can also occur after trauma)
  • Pain often worse at night
  • Loss of rotation (taking your hand away from the body) followed by flexion (reaching) and abduction (reaching sideways)

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy- during the freezing and frozen stage maintenance exercises can be given. Once reached the thawing stage strengthening exercises and range of movement exercises can be introduced.
  • Orthopaedic options are available including manipulation under anaesthetic and Hydrodilitation

Investigations

  • X-ray to rule out bony pathology (e.g. dislocation or OA), should come back normal

Exercises to try:

Pendulum

Pendulum

Leaning your asymptomatic arm onto a chair or table 

Let your symptomatic shoulder relax and hang

Then gently swing either forwards and backwards or in circles letting gravity do most of the work 

Isometric ER

Isometric External Rotation

Standing next to a wall or door

Bend your elbow to 90 degrees 

Try to push your forearm into the wall and hold for 30-45 seconds

Relax and then repeat 

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