I Have Frozen Shoulder, What Now?

Adhesive Capsulitis, more commonly known as Frozen Shoulder, is reported to affect roughly 2-5% of the population. Should you have other comorbidities such as Diabetes or Thyroid Disease, your risk could increase to anywhere from 4.3 to 38% (large variability).

So, what is it exactly? Interestingly, recent findings have found the histological (anatomy under a microscope) nature of Frozen Shoulder to resemble the tissue of a Dupuytren's contracture, which can often occur in the hand. Simply put, it is a condition where there is thickening and contraction of the shoulder capsule. Uncertainty remains if there is actual inflammation or adhesions, and the exact pathology, definition, and treatment has remained variable over the years (Hand et al. 2007, Smith et al 2012).

When you attend an assessment with a CAMPT physiotherapist, it may be found that you have a loss of range of motion in multiple planes of motion, not only when you try and move your arm, but also when your therapist moves your arm. This signifies that it may be more than purely a muscular dysfunction. The loss of rotation at the shoulder can make activities like scratching your back, putting on your seatbelt, and washing your hair quite difficult. As mentioned above, Diabetes and Thyroid Disease are risk factors, and individuals ages 40 to 65 years of age, and of female gender seem to be at higher risk. If you have had a previous episode of frozen shoulder in the other arm, you also are considered to be at a higher risk. Although the length of time to recovery remains variable, Reeves (1975) described the average duration of lasting ~30 months.

The condition will progress through stages of pain and mobility deficits. In the first stage, the pain is greater than the feeling of stiffness. If you are reading this and have had, or currently have a frozen shoulder, you may have noticed that the onset and development of your symptoms and stiffness was quite gradual and progressive, with no real incident or injury. This is quite common. Patients often have difficulty obtaining a clear diagnosis in the early stages of this pathology, and note some persisting disruption to their sleep/wake cycle.

An assessment from your CAMPT Physiotherapist can aid in diagnosis clarification, ensuring that the shoulder pain is not tendonitis, bursitis, arthritis, impingement syndromes, or other non-musculoskeletal pathologies, and confirm that the presentation is that of a true primary or secondary frozen shoulder. As you can imagine, proper diagnosis is key to the appropriate and timely management of most conditions.

Your physiotherapy may have you fill out questionnaires such as the Shoulder Pain and Disability Index or Disabilities of the Arm, Hand and Shoulder to track your pain/mobility deficits over the following number of months, and to ensure treatment is making a clinically relevant change.

Your therapist will continue to measure range of motion, both with you moving your shoulder (active), and with your therapist moving your shoulder (passive), looking for key impairments specific for your case, and looking for areas that may be beneficial to address over the coming months.

In later stages of the condition, the pain reduces, and stiffness is the predominant complaint. Your CAMPT physiotherapist may begin to increase the use of both “hands-on” manual therapy techniques, as well as progress your active rehabilitation exercises to ensure a continued focus of both range of motion and strength.

To date, there is no strong evidence for any surgical procedure that can speed up the process of recovery, but based on the research available, a properly staged/structured rehabilitation plan can lead to not only better pain and function, but also better overall patient satisfaction with what can be quite a long/frustrating condition.

Warm Regards,

Travis Gaudet MScPT., FCAMPT., DipManipPT., cGIMS., CFST-1., CAFCI

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