Adhesive Capsulitis/Frozen Shoulder

Frozen shoulder is medically termed Adhesive Capsulitis and is a condition which affects the capsule around the glenohumeral joint whereby the capsule becomes inflamed, swollen and contracted. As a consequence the normal elasticity of the capsule is replaced by pain and stiffness

The cause of adhesive Capsulitis is largely unknown. This condition can occur as a result of trauma but often this condition comes on gradually without any known reason. The patients are often female and between the ages of 40-60 years and there tends to be a predominance for this condition in the nondominant arm. Adhesive Capsulitis has also been found to be associated with Diabetes, thyroid complaints, Cervical Spondylitis, Rheumatoid Arthritis and heart disease. Furthermore, it is now believed that there may be an autoimmune component to this condition whereby the body’s immune system attacks the healthy tissue in the shoulder

There are three characteristic stages for Adhesive Capsulitis

• The painful freezing phase:
• duration 10-36 weeks
• pain and stiffness around the shoulder with no history of injury. Often the patient experiences night pain
• adhesive phase:
• after several months (occurs at 4-12 months), the pain begins to subside but the shoulder stiffness remains
• pain is only apparent but only at the extremes of movement
• recovery phase:
• over a further period of 12-42 months there is a gradual, although possibly incomplete, return of shoulder movement

Clinically, in the early stages of this condition, there is severe loss of motion in all planes and often the patient is unable to sleep due to significant discomfort.

Adhesive Capsulitis is self resolving and as such the pain and stiffness in the glenohumeral joint will improve with time. However, often patients do seek advice and guidance with regards to this condition as it can be very incapacitating both with regards to carrying out day to day tasks (putting on coat, washing hair etc) due to pain and lack of mobility. Patients are often very worried and concerned when this condition first starts and often feel much better once a diagnosis is given and a description of the complaint is explained.

Treatment for Adhesive Capsulitis/Frozen Shoulder

At the Bodymotion Chiropractic and Sports Injuries clinic, treatment in the early stages is focused on trying to alleviate some of the inflammation and pain through icing. Often during this stage of the injury, patients have visited their GPs and have been advised to take antiinflammatories and painkillers.

As the treatment progresses, our EC2 chiropractors will direct most treatment towards reducing the muscle guarding around the shoulder girdle to try and alleviate some of the referred pain form the localised muscle spasm. In addition, mobilisation therapy will be utilised to gently break down the adhesions in the capsule of the glenohumeral joint. As the mechanics in the neck, mid back and shoulder are so closely linked, treatment will also involve loosening up the stiff joints and muscles in these areas.  Exercises will also be prescribed to improve posture, improve flexibility of the glenohumeral joint and to strengthen the shoulder.  

In some cases, patients will have surgery for this complaint which often involves manipulation of the shoulder under anaesthetic or surgical release of the tight shoulder capsule using arthroscopic techniques

Research to support this type of physical therapy in the treatment of Adhesive Capsulitis includes:

Vermeulen HM, Rozing PM, Obermann WR, LeCessie S, Vliet Vieland TP. Comparison of high grade and low grade mobilisation techniques in the management of adhesive capsulitis of the shoulder randomised controlled trial Phys Ther 2006 Mar; 86(3): 355-68

Van den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Austr J Physiotherapy 2003; 49(3): 183-8