Adhesive Capsulitis (Frozen Shoulder):
Causes, Symptoms & Treatment
Adhesive Capsulitis and Frozen Shoulder are terms which are used to describe a condition when the shoulder becomes painful, stiff and difficult to move. It’s currently considered that Adhesive Capsulitis (Frozen Shoulder) has an unknown cause but clinical presentation demonstrates an individual who has significant reduction in both passive and active shoulder joint range of motion. Imaging of the shoulder joint usually shows no abnormality. Many shoulder conditions effect active range of motion however the obvious loss of passive range of motion is considered a hallmark feature of Adhesive Capsulitis (Frozen Shoulder). Symptoms of this condition are generally divided into three phases; freezing (painful stage), frozen (stiffening stage) and thawing.
Phases Of Adhesive Capsulitis
- Freezing (Painful): The initial phase of Adhesive Capsulitis is marked by a gradual onset of shoulder pain that may persist for weeks to many months.
- Frozen (Stiffening): The second phase is characterized by a progressive loss in shoulder movement.
- Thawing: The final phase is marked by a slow but gradual improvement in movement and reduction of shoulder pain.
Adhesive Capsulitis Epidemiology
The mechanism of Frozen shoulder remains unclear. The condition is classified as either primary or secondary. Frozen shoulder is considered primary if the onset is idiopathic (unknown) while secondary is classified when there is an obvious cause. Frozen shoulder syndrome typically affects people between the ages of forty to sixty, with more females then males affected. It’s estimated that between 2 – 5% of people will suffer from this condition during their lifetime. Adhesive Capsulitis rarely occurs in both shoulders. Diabetes Mellitus has been identified as a major risk factor for developing Frozen shoulder with Diabetics being up to five times more likely to develop symptoms.
Conditions Which Mimic Adhesive Capsulitis
It’s important to rule out other potential diagnoses which will influence that treatment that you receive. Below you’ll discover a list of conditions which must be ruled out by your practitioner.
- Shoulder Joint Osteoarthritis: Both conditions present with loss of shoulder movement and pain. Shoulder joint radiography should be used to rule out Osteoarthritis.
- Shoulder Impingement Syndrome: Affects the Supraspinatus tendon of the shoulder. Hallmark feature is pain during arm abduction. Other ranges of motion are typically normal.
- Shoulder Bursitis: The pain and stiffness between both conditions is similar. The major distinguishing feature is that range of motion will be generally greater in Bursitis sufferers.
- Rotator Cuff Injury: Individuals suffering from Rotator Cuff pathology may note reductions in range of motion and strength however additional imaging such as MRI and Ultrasound will rule out Frozen shoulder.
- Glenohumeral Joint Dislocation: Usually occurs following direct trauma.
Physical Examination Of The Shoulder Region
Your practitioner may ask you to complete one of the following outcome measures:
- Shoulder Pain & Disability Index
- Disability of Arm, Shoulder & Hand Scale
- Visual Analogue Scale
A typical shoulder region physical examination may include (but is not limited to):
- Observation for potential scapula winging, deformity, unlevelving of the shoulders and general posture.
- Range of motion assessment of the shoulder, cervical and thoracic spine to determine the extent of limited movement.
- Muscle strength testing to assess surrounding muscles of the shoulder joint to ascertain if muscle weakness is apparent.
- Neurological & Orthopaedic assessment of your dermatomes, myotomes and reflexes to rule of potential serious pathology involving the cervical spine and associated structures.
Adhesive Capsulitis Treatment Options
Adhesive Capsulitis is a self-limiting condition but it may take many years for people to notice improvement. Sufferers can address pain, loss of movement and general function through manual therapy. Your treatment should consist of physical therapy, anti-inflammatory measures and exercise.
Chiropractic & Physiotherapy
Physical therapy such as provided by Chiropractors & Physiotherapist’s assist individuals with improving range of motion, reducing pain and therefore improving quality of life. Treatment that may be administered by such professionals may include:
- Mobilization of the cervical and thoracic spine and shoulder girdle complex
- Soft tissue massage to the shoulder structures to assist with pain reduction and mobility
- Postural exercise advice to assist with scapular and shoulder stability
- Physiological therapeutics such as Ultrasound, Shockwave therapy and low level laser treatment to assist with reducing inflammation
Chiropractor Adhesive Capsulitis Research
- Individuals suffering from Adhesive Capsulitis (Frozen Shoulder) demonstrated greater improvement following high-grade shoulder mobilization techniques compared to low-grade mobilization techniques. Vermeulen, H. (2006). Comparison of high-grade and low-grade mobilization techniques in the management of Adhesive Capsulitis of the shoulder: Randomized controlled trial. Physical Therapy, 86(3); 355 – 368.
- Majority of patients presenting with Adhesive Capsulitis demonstrated clinically significant improvement following Chiropractic management consisting of cervical, thoracic and shoulder joint manipulative therapy. Murphy, F. et al., (2012). Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients. The Journal of Chiropractic Medicine, 11(4); 267 – 272.