How to Treat Frozen Shoulders with Physiotherapy Services and More

Adhesive capsulitis, commonly known as frozen shoulder, is a disease that affects the most flexible joint in the body (1), the shoulder joint, causing stiffness and pain as the name suggests.

It can be primary or idiopathic with no known cause. However, hormonal imbalances or systemic diseases can increase the risk. Or it can be secondary and caused by external factors such as injury, surgery, or immobility.

The condition occurs slowly with symptoms of pain and discomfort around the deltoid insertion at the tip of the shoulder, making it quite difficult for the patient to sleep on the affected side. The abduction and external rotation of the shoulder are limited.

Frozen shoulder symptoms can be mistaken for rotator cuff tendonitis. The latter, however, mainly manifests itself in pain caused by the inflamed muscle tendons at the end of the bone. With the former, however, the main complaint is restricted mobility along with longstanding chronic pain.

A rotator cuff is a group of muscles that stabilize the shoulder joint while allowing it to move in extreme areas. Tendonitis or bursitis of the shoulder may be different from frozen shoulder, but these conditions can act as a causal factor if not treated in a timely manner.

The pathophysiology of the frozen shoulder is not fully understood; However, radiological studies show thickening of the joint capsule and the adjacent coracohumeral ligament, and histological studies performed on tissue from the affected area revealed fibroblasts and chronic inflammatory cells. These results suggest an underlying inflammatory process that may have been triggered by injury or illness after a long period of immobility.

Clinically, the frozen shoulder goes through three phases, commonly referred to as the freeze, freeze, and thaw phases.

The freezing phase lasts 6-9 months. It can be further divided into 3 levels. The acute, subacute and chronic.
The acute stage is characterized by persistent pain that worsens at night.
During the subacute stage, pain occurs only at night.
In the chronic stage, only movement is painful and restricted, and there is no pain at rest.
The freezing phase lasts 6-12 months. During this phase the patient is somewhat, or in some cases completely, pain free. However, daily living activities (ADLs) are severely impaired and the patient is unable to perform simple tasks such as combing their hair due to restricted mobility due to stiffness.
The thawing phase is mainly the recovery phase, which can take up to two years. Joint stiffness slowly decreases and the patient returns to normal activities.

The frozen shoulder may return after recovery, especially in the high-risk population. The factors or conditions that predispose a person to frozen shoulder include:

Female gender
Age over 40.
Recent operations, i. H. Mastectomy, cardiac, or upper extremity surgery.
diabetes
Parkinson's disease
Thyroid disease
Improper treatment of a previous shoulder injury

The physical findings of a frozen shoulder include restriction of passive external rotation of the joint. The final diagnosis is made by inspecting the affected shoulder and examining it through physical tests, X-rays, and MRIs to rule out other possible causes of pain and stiffness such as arthritis, tendonitis, strain / sprain, bone tumors, or joint dysfunction.

Frozen shoulder treatment is carried out taking into account the degree of disability and the severity of symptoms of each patient in order to achieve the most effective intervention.

Patient counseling is the most important step in disease management that satisfies and encourages the patient for therapy and recovery. Knowledge is power.

Educating the patient about their symptoms, treatment options, and prognoses creates a sense of control and leads to patient compliance.

Here are some conventional shoulder treatments:

Over-the-counter pain relief

Medication, cooling gel, hot and cold packaging, and cryotherapy are the most suitable measures during the freezing phase to overcome the pain.

Therapeutic ultrasound methods

Transcutaneous electrical nerve stimulation (TENS) and interference therapy relieve pain and inflammation. Electrotherapy works best in conjunction with physical therapy.

physical therapy

Started after the pain was treated. It starts with inferior exercises like passive stretching, motion exercises, and light joint mobilizations within a pain-free area. Then it goes on to isometric strengthening of the muscles of the upper extremities.

Aggressive mobilizations are contraindicated as they do not give better results than mild exercises. A great place in Mississauga is the Gray Method – physical therapy and massage therapy.

Corticosteroid therapy

This can be used in conjunction with physical therapy for patients with severe symptoms when the benefits replace the side effects of steroids.

Manipulation under anesthesia

Although unusual, this method of treatment is used in cases of severe stiffness. In this procedure, the patient is given local anesthesia and then the humerus is moved in flexion, external rotation, external rotation with abduction, and finally internal rotation with abduction. Physical therapy must be continued after the procedure. It provides long-term relief from stiffness.

However, some studies find negative consequences for this aggressive approach, including intra-articular lesions such as bleeding, rupture, tears, and osteochondral defects.

Distension arthrography or hydro-dilation

A procedure in which sterile water is injected into the joint at such a pressure that the contracted capsule ruptures. An intra-articular steroid injection may follow.

This procedure is effective in treating the primary frozen shoulder and provides an immediate gain in reach. A comprehensive regimen of physical therapy must be followed to maintain the acquired area and advance the recovery process.

Open the surgical release

This form of relief can be used as a last resort when exercise and arthroscopic release do not produce results. It is also used in complicated cases of bleeding and spores where closed manipulation can prolong the injury.

Surgery is contraindicated in patients who cannot tolerate fluid changes (kidney or heart problems). The operation has its own risks. Post-operative pain, immobility to protect the incision, and long hospital stays are some of the undesirable aspects of this treatment modality. (1, 2)

Wong P, Tan HJSmj. A look back at frozen shoulder. 2010; 51 (9): 694.
Robinson C, Seah KM, Chee Y, Hindle P, Murray IJTJob, Band jsB. Frozen shoulder. 2012; 94 (1): 1-9.

About the author:

The author Sira is a physiotherapist by profession and is currently working on her Masters in Physiotherapy for Women's Health. She enjoys writing content on health and physical fitness, lifestyle change, and rehabilitation