Common conservative treatments for frozen shoulder include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids given orally or as intra-articular injections, and/or physical therapy.( 14) Many practitioners, however, find themselves limited to prescribing medications to relieve pain and inflammation.
FROZEN SHOULDER FULL
It is also advisable to acknowledge that full range of motion may never be restored. Explaining the natural history of the condition often helps to reduce frustration, increase compliance and allay fears for the patient. Clinicians are encouraged to start the treatment with patient education. Most frozen shoulder cases can be managed in the primary care setting. As the physical therapy described in this article is specifically targeted at adhesive capsulitis, techniques for other shoulder conditions require further customisation. rotator cuff tendinopathy, subacromial bursitis and impingement syndrome) can closely resemble frozen shoulder in the early stages as well.( 7) For appropriate management, it is important for physicians to ascertain the diagnosis. The term ‘frozen shoulder’ is often loosely used and wrongly attributed to other shoulder limitations such as a rotator cuff tear or osteoarthritis. It most commonly affects those in their fourth to sixth decades of life, and more often occurs in women than in men.( 8, 13)
HOW COMMON IS THIS IN MY PRACTICE?įrozen shoulder is estimated to affect 2%–5% of the general population,( 12) and can be significantly painful and disabling. Icons with facial expressions represent the level of pain of the patient. During the thawing stage, the patient experiences a gradual return of range of motion that takes about 5–26 months to complete.( 7, 8) Although adhesive capsulitis is often self-limiting, usually resolving in 1–3 years,( 9) it can persist, presenting symptoms that are commonly mild pain is the most common complaint.( 10, 11)Ĭhart shows the clinical presentation of frozen shoulder. The pain will begin to subside during the frozen stage with a characteristic progressive loss of glenohumeral flexion, abduction, internal rotation and external rotation. In the freezing stage, which lasts about 2–9 months, there is a gradual onset of diffuse, severe shoulder pain that typically worsens at night. These patients develop pain from the shoulder pathology, leading to reduced movement in that shoulder and thus developing frozen shoulder.įrozen shoulder often progresses in three stages: the freezing (painful), frozen (adhesive) and thawing phases ( Fig. rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis). Secondary adhesive capsulitis can occur after shoulder injuries or immobilisation (e.g. Primary idiopathic frozen shoulder is often associated with other diseases and conditions, such as diabetes mellitus, and may be the first presentation of a diabetic patient.( 3) Patients with systemic diseases such as thyroid diseases( 4, 5) and Parkinson’s disease( 6) are at higher risk.
WHAT IS FROZEN SHOULDER?įrozen shoulder, also known as adhesive capsulitis, is defined as “ a condition of uncertain aetiology, characterised by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder”.( 1) Patients with frozen shoulder typically experience insidious shoulder stiffness, severe pain that usually worsens at night, and near-complete loss of passive and active external rotation of the shoulder.( 2) There are typically no significant findings in the patient’s history, clinical examination or radiographic evaluation to explain the loss of motion or pain.įrozen shoulder can be classified as primary or secondary. However, due to her history of gastric problems, you were keen to explore physical therapy as part of management. You previously gave her painkillers as treatment. She had an aching pain on her shoulder and, lately, had increasing difficulty lifting her arm or reaching behind her back. Lucy, a 53-year-old woman, visited you several times in the past year.