FROZEN SHOULDER
The precise cause of frozen shoulder is unknown. It can occur after an injury to the shoulder or following prolonged immobilization, such as after surgery or arm fracture. People who have diabetes have a greater risk of frozen shoulder. For this reason, frozen shoulder may have an autoimmune component, in this case the immune system attacking the capsule and connective tissue of the shoulder. People with other health conditions including heart disease, lung disease and hyperthyroidism may also have an increased risk of developing this condition.
Typically frozen shoulder tends to present more predominantly in middle aged females and more often in the non-dominant arm. History can sometimes point to some early form of cuff inflammation.
When frozen shoulder occurs, the shoulder capsule becomes inflamed and stiff. The inflammation may cause bands of tissue (adhesions) to develop between the joint's surfaces. Synovial fluid, which helps to keep the joint lubricated and moving smoothly, may decrease. As a result, pain and subsequent loss of movement may occur. In some cases, mobility may decrease so much that performing everyday activities such as combing your hair, brushing your teeth or reaching for your wallet in your back pocket becomes difficult or even impossible. This process commonly occurs over a 12 month to 2 year time-frame if left untreated.
The cycle tends develop in the following pattern:
- Pain (pain is primary symptom – early cuff tear?)
- Pain with stiffness (pain is major concern with some stiffness beginning to develop at end-range of movement)
- Stiffness with some pain (stiffness is main symptom)
- Stiffness
Results Physiotherapy has developed a unique and hands-on approach to the treatment and resolution of frozen Shoulder.
The treatment focus must be multi-factorial and consideration must be given to the stage of the condition and thus the inflammatory status of the capsule. Not all patients will tolerate an immediate aggressive stretching of capsular tissue.
Aims of treatment include:
- Restoration of ROM via soft tissue releasing, passive stretching, massage and joint mobilization
- Decreasing inflammation (ice, medications)
- Improving strength of thr rotator cuff and also scapular stabilizers
- Gradual return to functional activities
Results Physiotherapists are trained to assess the capsular stiffness in detail. Isolating and passively stretching particular regions of the capsule and progressing gradually to more global patterns boosts patient compliance to the treatment whilst restoring range of motion. The posterior aspect of the capsule is usually the last to resolve.
The shoulder girdle as a whole, incuding cervical spine, thoracic spine, 1st rib and the surrounding musculature can all become stiff and inflamed which can add to the pain and result in additional immobilization which can delay the resolution of the capsular symptoms.
Strength due to prolonged immobilization always needs to be addressed. Rotator cuff drills beginning initially with simple patterns and dumbbells progressing to more graduated resistance is prescribed in conjunction with scapular stability exercises.
A home program of active assisted leading to active range of motion drills with strength work will augment and facilitate early resolution of inflammation and stiffness.
At Results Physiotherapy, an extensive understanding of current literature and past research has assisted us in developing unique rehabilitation parameters. Our rehabilitation approach for Frozen Shoulder is on many years of international clinical experience incorporating a multi-factorial approach to the resolution of this debilitating condition. We aim to link with leading physicians and specialists in 2009 to perform our own research on the outcomes of our unique treatment paradigm.
