Frozen Shoulder

Adhesive Capsulitis/Frozen ShoulderShoulder

As a physiotherapist living in Winnipeg, I come across a lot of “frozen situations” throughout the
winter. One of them being frozen shoulder, also known as adhesive capsulitis. Frozen shoulder is associated with synovial inflammation and a capsular contracture/restriction of the shoulder joint.

What are the main causes?

The five main causes of frozen shoulder include:

  • Post-surgical
  • Idiopathic (unknown)
  • Post-trauma to the shoulder
  • Diabetes
  • Rotator cuff/impingement induced stiffness

Along with the above causes, other predisposing factors to frozen shoulder include diabetes, females and being between the ages of 40-65.

What is the typical presentation?

The 3 stages of frozen shoulder are:

  • Freezing/painful phase – a gradual onset of pain that becomes sharp and intense at extreme ranges of motion. Often pain is worse at night.
  • Frozen phase – Pain gradually subsides, and shoulder range of motion significantly decreases in external rotation and abduction, causing a stiffness sensation.
  • Thawing phase – A slow, progressive improvement in range of motion and reduction in pain.

The entire process can last from 3 months to 3 years. Throughout this time, muscles imbalances often occur, causing movement pattern dysfunctions such as shoulder hiking and/or shoulder blade winging.

What are the treatment options?

The goals for treatment are to decrease pain levels, and restore range of motion and strength. A physician may recommend medications (non-steroidal anti-inflammatory drugs), or a corticosteroid injection to reduce inflammation.

Physiotherapy is often prescribed for frozen shoulder. Physiotherapy treatment focuses on improving range of motion and muscle/motor control. Treatment techniques may include joint mobilization, soft tissue manipulation, stretching, range of motion and strengthening exercises when appropriate, acupuncture, and laser therapy.

Clinically, there is no definitive treatment plan for frozen shoulder. Although, the literature does suggest that physiotherapy treatment provided at the right stage  has been shown to reduce pain levels and disability, and improve function.

If you have shoulder pain, contact a physiotherapist to determine the best possible treatment plan for you!


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