Frozen shoulder otherwise called adhesive capsulitis

The term ‘frozen shoulder’ is often loosely used and wrongly attributed to other shoulder limitations such as a rotator cuff tear or osteoarthritis. Clients with frozen shoulder typically experience shoulder stiffness, severe pain that usually worsens at night, and near-complete loss of passive and active external rotation of the shoulder.[1]

There are typically no significant findings in the patient’s history, clinical examination or radiographic evaluation to explain the loss of motion or pain.

Frozen shoulder can be divided into primary and secondary categories. There is a relationship between primary idiopathic frozen shoulder and some diseases and other conditions such as diabetes mellitus cardiac disease, hyperthyroidism and hypothyroidism conditions. (2) The occurrence of secondary adhesive capsulitis, on the other hand, can be attributed to the aftermath of shoulder injuries or immobilization (for example, rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis, and calcific tendonitis). In addition to the two classes of frozen shoulder, there are three phases of the frozen shoulder which are: the freezing (painful), frozen (adhesive) and thawing phases

Phase 1 Freezing
This phase is characterized by severe pain followed by a progressive loss of range of movement. During this phase, the patient benefits from learning pain-relieving techniques. Some of these techniques include gentle shoulder movement within the endured range (for example pendulum work out, passive supine forward elevation, passive external rotation, and active-assisted range of motion in extension, horizontal adduction, and internal rotation).

Phase 2 Frozen
The early transition from phase one to two can be painful. Late phase two is generally pain-free but functionally limiting due to the stiffness Like the freezing phase, a warmth or ice pack can be used amid the frozen phase to alleviate pain before the beginning of activities. In addition to this, some home activities can be done within the tolerated limit. Specifically, things that need to be done include stretching exercise for the chest muscles and muscles at the back of the shoulder which must be adhered to. It is also advisable to engage in elevation exercises such as an external rotation stretch. This is done to avoid an increase in pain and inflammation. (3) 

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Phase 3 Thawing 
During this phase, the patient encounters a gradual return of range of motion. It is essential to get the shoulder back to its normal position as quickly as possible by regaining whole movement and strength. Moreover, strengthening workouts are crucial; this is because the shoulder is severely weakened after some months of little movement.

A note on treatment options
Treatment options which can be used as a first-line of treatment for adhesive capsulitis include physical therapy and home exercises. (4) Physical therapy is known for its effectiveness in alleviating pain and restoring of functional motion. (5) The use of physical therapy in tandem with NSAIDs makes it more effective than using NSAIDs alone. (6) Similarly, some investigations on intra-articular corticosteroids when used in combination with physical therapy brought about better results when compared with intraarticular corticosteroids alone. (7, 8)

This article is based on the paper 
Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J. 2017;58(12):685-689. LINK

​REFERENCES

1. Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011;20:322–3.
2. Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus. Br J Rheumatol 1986; 25:147-51.
3.  Donatelli R, Ruivo RM, Thurner M, Ibrahim MI. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient. Phys Ther Sport 2014; 15:3-14
4. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg 2011; 20:502-14 
5. Page P, Labbe A. Adhesive capsulitis: use the evidence to integrate your interventions. N Am J Sports Phys Ther 2010; 5:266-73.
6. Dudkiewicz I, Oran A, Salai M, Palti R, Pritsch M. Idiopathic adhesive capsulitis:long-term results of conservative treatment. Isr Med Assoc J 2004; 6:524-6.
7.  Page MJ, Green S, Kramer S, et al. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2014; (10):CD011324.
8. Mobini M, Kashi Z, Bahar A, Yaghubi M. Comparison of corticosteroid injections, physiotherapy, and combination therapy in treatment of frozen shoulder. Pak J Med Sci 2012; 28:648-51.