Frozen Shoulder

By Dr. Jeanette Kochman, PT, DPT, OCS

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by loss of shoulder motion and pain. It can be quite disabling. The cause or origin of the condition is unknown.  Diagnosis is primarily determined by history and physical examination.

It is known that patients with diabetes mellitus and thyroid disease are at risk for developing adhesive capsulitis, and adhesive capsulitis is more prevalent in individuals who are 40 to 65 years of age, female, and have had a previous episode of adhesive capsulitis in the other arm.

Four stages of frozen shoulder have been described:

  • Stage 1 may last up to 3 months, and during this stage patients describe sharp pain at end ranges of motion, achy pain at rest, and sleep disturbance.
  • Stage 2 can last 3 to 9 months and is known as the painful or “freezing” stage where patients experience a gradual loss of motion in all directions (active and passive motion) due to pain. Functional activities such as reaching overhead, behind the back, or out to the side become increasingly difficult due to pain and/or stiffness.
  • Stage 3 can last 9 to 15 months and is known as the “frozen” stage where there is persisting significant loss of motion and pain.
  • Stage 4 lasts 15 to 24 months after the onset of symptoms and is known as the “thawing” stage. Pain begins to resolve in this stage and there is a gradual return of motion, but stiffness can persist.

Common conservative treatments include nonsteroidal anti-inflammatory drugs (NSAIDS), oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy.

Physical therapy has been shown to provide pain relief and return of functional motion.

Physical therapists assess the level of tissue irritability, which means we categorize the shoulder based on pain intensity and frequency, as well as active and passive range of motion. Treatments are tailored appropriately. As the level of tissue irritability decreases, therapists progress treatments. Treatments include the use of modalities for pain relief, patient education, manual therapy techniques, and prescribing appropriate range of motion, stretching and muscle re-education exercises.

It is very important in the freezing stage to do short duration gentle stretches, and to modify activities at home to avoid producing more tissue irritation and pain. Consulting with a physical therapist to guide you through this phase, monitor your symptoms, and determine when it’s safe to advance home activities and exercises is paramount to your recovery and return to recreational activities.

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