Mainy stiff and painful shouders can be mis-takingly diagnosed as frozen shoulders. Painful shoulder impingements and pain referred from the cervical spine can have presentations in common with a frozen shoulder but respond very poorly to treatment directed at a frozen shoulder. A mis-diagnosis can lead to a delay in appropriate physiotherapy intervention and a prolonged period of discomfort for the patient.
So what is a frozen shoulder? Adherent bursitis, adhesive capsulitis, pericapsulitis are just some of the terms used to define the condition of a ‘stiffening or frozen shoulder’, each is a description of the potential underlying disease process (Siegel et al, 1999). The term ‘Frozen shoulder’, first used by Codman in 1934, describes a gradual onset of shoulder pain, progressive reduction of range of motion and discomfort sleeping on the affected side (Pearsall and Speer, 1998).
The exact cause of frozen shoulder remains unclear. Some theorized that the disease results from a thickening and tightening of the normally flexible and elastic joint capsule leading to a contracture (Neviaser and Neviaser, 1987) while other suggest the cause originating from an inflammatory response leading to scar tissue formation (Hanafin and Chiaig, 2000).
Frozen shoulder usually occurs with no prior injury or notable cause but can follow traumatic injuries such as fractures where the arm is immobilised for a prolonged period of time. You may be more likely to develop the condition if you have one or more of the following risk factors:
3:1 female to male ratio (Walker et al, 1997)
Most presenting cases 40-60 years of age
History of diabetes, thyroid or heart disease (Walker et al, 1997)
Dupuytren’s contracture (Schaer et al, 1936; Smith et al, 2001)
The two types of frozen shoulder are defined by whether the cause is known or unknown:
Primary adhesive capsulitis is characterised by an insidious progressive painful loss of active and passive glenohumeral joint motion (Hannafin and Chiaia, 2000).
Secondary adhesive capsulitis presents in the same way as primary but stems from a known underlying illness or extrinsic cause (Hannafin and Chiaia, 2000)
STAGES OF FROZEN SHOULDER
Freezing ‘Painful’ Phase: Pain increases with movement, often worse at night, progressive loss of motion with increasing pain (Duration approx: 2 to 9 months)
Frozen ‘Stiff’ Phase: Pain begins to diminish,significantly reduced range of motion (as much as 50% less than in the other arm) (Duration approx: 4 to 12 months)
Thawing ‘Recovery’ Phase: Condition may begin to spontaneously resolve, most patients experience a gradual restoration of motionover the next 12 to 42 months Apply heat or cold packs to help reduce and manage the pain Consult your GP for advice regarding pain medication/anti-inflammatories See your physiotherapist for advice and treatment
Physiotherapy treatment for frozen shoulder aims to restore normal range of motion to the joint, increase tissue extensibility and improve strength of the muscles around the shoulder: Pain management Graduated stretching programme Passive joint mobilisations Ultrasound/Soft tissue massage Specific home exercise programme Postural re-education
Some evidence suggests that physiotherapy intervention can have a more profound impact on the condition in the earlier stages (Mao et al, 1997). However most patients do not seek help until pain and loss of range of motion begin to affect day to day tasks. If you begin to notice any symptoms, seek advice from your physiotherapist or local health care professional.
Hannafin., JA., Chiaia, TA (2000) Adhesive capsulitis: A treatment approach, Clinical Orthopaedics and Related Research, 372, 95-109.
Mao,. CY., Ja., WC., Cheng., HC (1997) Frozen shoulder: Correlation between response to physical therapy and follow-up shoulder arthrography, Archives of Physical Medicine and Rehabilitation, 78: 857-859.
Neviaser , RJ., Neviaser TJ (1987) The frozen shoulder: Diagnosis and management. Clinical Orthopaedics, 233:59–64.
Pearsall., AW., Speer., K P (1998) Frozen shoulder syndrome: Diagnostic and treatment strategies in the primary care setting, Medicine and Science in Sports and Exercise, 30: 33-39.
Schaer, H (1936) Die aetiologie der periarthiritis humeroscapularis, Ergebn Chir Orthop, 29: 11.
Siegel, L., Cohen, N., Gall, E (1999) Adhesive Capsulitis: A Sticky Issue’, American Family Physician, 59(7):1843-1850.
Smith et al (reference in Watson’s shoulder manual)
Walker, K., Gabard, D., Bietsch, E., Masek-VanArsdale, D., Robinson, B (1997) A profile of patients with adhesive capsulitis, Journal of Hand Therapy, 222-228.