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:
- 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.
- 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.
- 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
