Frozen ShoulderAdhesive Capsulitis (AC), or Frozen Shoulder, is a common condition causing stiffness and pain in the shoulder. AC affects 2-5% of the population and up to 20% of people with diabetes. It may also be associated with high cholesterol, heart disease and rheumatic conditions. AC is a condition in which the shoulder is completely or partially unmovable (stiff). Along with often intense shoulder pain, AC presents with progressive limitations in both active range of motion (joint movement you can achieve alone) and passive range of motion (movement achieved when someone else moves the joint). The cause of this debilitating condition is not fully understood. It is believed that the shoulder (glenohumeral) joint capsule, a band of connective tissue surrounding to head of the humerus, along with shoulder ligaments, become red, swollen and inflamed, leading to shortening and stiffness (contracture) and a loss of the capsules normal elastic quality.  AC generally affects people aged 40 – 65 years, it can occur spontaneously, with mild injury, or secondary to another condition. Night pain is a common feature. X-ray investigation is often normal. Symptoms of AC can mimic other conditions such as osteoarthritis, for example, which can make diagnosis difficult, but physiotherapists are well placed to diagnose AC using a thorough history and physical assessment. For some time it was believed by many that AC followed a natural history theory. If initially ‘frozen’ it would suggest it could thaw. The theory was that the condition moved from painful (freezing), stiff (frozen), through to (thawing) recovery / complete resolution. Furthermore, it was believed that the condition would improve over time (usually 2 – 3.5 years) without any intervention. We can now confidently say that these theories have largely been disproven. No longitudinal evidence supports the natural history theory and there is moderate evidence stating that most improvement occurs early, not late; therefore, the key in AC is early diagnosis and early treatment. A delay in treatment may in fact lead to worse outcomes.  Physiotherapy The team here at PhysioImpulse can help identify many causes of shoulder pain and stiffness and support in the management of these debilitating conditions. Treatment of AC is focused on restoring normal range of movement and returning the joint back to its previous function. Shoulder joint injections are commonly used for AC and these injections aim to reduce inflammation and also act as pain relief. However, there is no ‘gold standard’ treatment regime; your physiotherapist will work with you to create a plan tailored to you. Early mobilisation with physiotherapy is generally recommended as first-line treatment; a variety of techniques may be used. One of these is ‘hands-on’ physiotherapy using joint mobilisation techniques. These aim to gently stretch the joint capsule by performing passive mobilisations at varying points throughout the shoulder range. Your physiotherapist will support this with appropriate exercise therapy and activity management advice. For Further information on Adhesive capsulitis or any other condition just call the number below or email therapists@physioimpulse.co.uk 01225 683007
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AuthorPhysioimpulse Chartered Physiotherapists Archives
February 2020
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