FROZEN SHOULDER (ADHESIVE CAPSULITIS)
A large, United Kingdom (UK)-based primary care study found that, “often called a stiff or ‘frozen shoulder’,” adhesive capsulitis occurs in about 8.2% of men and 10.1% of women throughout the population. It affects women more than men and is typically diagnosed in people over the age of 45. Of the people who have had adhesive capsulitis in 1 shoulder, it is estimated that 20% to 30% will get it in the other shoulder as well. Physiotherapists help people with adhesive capsulitis address pain and stiffness, and restore shoulder movement in the safest and most effective way possible.
Your Care Pathway with Us
- To book an appointment you can call our normal reception line, 0142084487, email direct to firstname.lastname@example.org click the button given below.
- Complete MSK Examination and testing.
- Detailed MSK ultrasound scan.
- Discussion of your treatment plan; Treatment Plans can include i.e advanced treatments for ex. Cortisone Injection, Ostenil plus (Hyaluronic injection), Prolotherapyor Conservative management like physiotherapy, massage, acupuncture, shockwave therapy and laser therapy.
What our Patients say?
Injection Therapy for Frozen Shoulder
If the pain persists and is interfering with your everyday activities, injection therapy may be necessary. Injection therapy is particularly useful in the following situations:
- If you’re in a lot of pain, particularly if it’s waking you up multiple times a night, an ultrasound-guided steroid injection is the way to go. The medical literature backs up this argument.
- Pain that prevents you from performing daily tasks such as washing and dressing, cooking, or engaging in recreational activities.
- Your desire to participate in physiotherapy recovery is being hampered by pain.
Steroid injections were found to be the most effective treatment for frozen shoulder in stage one, the “painful stage,” according to a recent systematic review (Wang et al., 2016). Patients find it hard to locate some pain relief at this point, and even minor movements worsen the pain. When pain becomes intense, it can take several hours or even days for it to subside. Frozen shoulder is treated with injections to relieve the pain and swelling. This gives you a ‘golden opportunity’ to stretch your shoulder properly. According to research, physiotherapy should begin within two weeks after getting a shoulder joint injection for the best results.
Injections performed under ultrasound image guidance are more successful at transmitting medication to the shoulder joint, and more effective at minimising pain and increasing function than injections performed using landmarks (Daniels et al., 2018; Aly et al., 2015). Ultrasound-guided injections have also been shown to significantly reduce pain that comes with frozen shoulder, particularly in the brief period, according to research. When injection therapy is combined with physiotherapy, this can be extremely beneficial.
How Do I Book a Cortisone Injection For Frozen Shoulder?
To book for a steroid injection you can call our normal reception line, 0142084487 or email direct to email@example.com requesting an appointment for an injection. Please include your name, date of birth, your address and GP contact details. You will be sent a form to complete and forward back to us or bring along on the day which gives information about the injection.
What is Frozen Shoulder (Adhesive Capsulitis)?
Adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause of adhesive capsulitis is a matter for debate. Some believe it is caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an “attack” against its own substances and tissues. Other possible causes include:
- Reactions after an injury or surgery
- Pain from other conditions, such as arthritis, a rotator cuff tear, bursitis, or tendinitis, that has caused a person to stop moving the shoulder
- Immobilization of the arm, such as in a sling, after surgery or fracture
Often, however, there is no clear reason why adhesive capsulitis develops.
Most people with adhesive capsulitis have worsening pain and a loss of movement. Adhesive capsulitis can be broken down into 4 stages; your physiotherapist can help determine what stage you are in.
Stage 1: “Pre-Freezing”
During stage 1 of its development, it may be difficult to identify your problem as adhesive capsulitis. You’ve had symptoms for 1 to 3 months, and they’re getting worse. Movement of the shoulder causes pain. It usually aches when you’re not using it, but the pain increases and becomes “sharp” with movement. You’ll begin to limit shoulder motion during this period and protect the shoulder by using it less. The movement loss is most noticeable in “external rotation” (this is when you rotate your arm away from your body), but you might start to lose motion when you raise your arm or reach behind your back. Pain is the hallmark feature of this stage; you may experience pain during the day and at night.
Stage 2: “Freezing”
By this stage, you’ve had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but it is limited by both pain and stiffness.
Stage 3: “Frozen”
Your symptoms have persisted for 9 to 14 months, and you have a greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage however, pain decreases, with the pain usually occurring only when you move your shoulder as far as you can move it.
Stage 4: “Thawing”
You’ve had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate.
How Is It Diagnosed?
Often, physiotherapists don’t see patients with adhesive capsulitis until well into the freezing phase or early in the frozen phase. Sometimes, people are being treated for other shoulder conditions when their physiotherapist notices the signs and symptoms of adhesive capsulitis. Your physiotherapist will perform a thorough evaluation, including an extensive health history, to rule out other diagnoses. Your physiotherapist will look for a specific pattern in your decreased range of motion called a “capsular pattern” that is typical with adhesive capsulitis. In addition, your physiotherapist will consider other conditions you might have, such as diabetes, thyroid disorders, and autoimmune disorders, that are associated with adhesive capsulitis
How Can a Physiotherapist Help?
Your physiotherapist’s overall goal is to restore your movement so you can perform your daily activities. Once the evaluation process has identified the stage of your condition, your physiotherapist will create an individualized exercise program tailored to your specific needs. Exercise has been found to be most effective for those who are in stage 2 or higher. Your treatment may include:
Stages 1 and 2
Exercises and Manual Therapy:
Your physiotherapist will help you maintain as much range of motion as possible and will help reduce your pain. Your therapist may use a combination of range-of-motion exercises and manual therapy (hands-on) techniques to maintain shoulder movement.
Your physiotherapist may use heat and ice treatments (modalities) to help relax the muscles prior to other forms of treatment.
Home Exercise Program:
Your physiotherapist will give you a gentle home-exercise program designed to help reduce your loss of motion. Your therapist will warn you that being overly aggressive with stretching in this stage may make your shoulder pain worse.
Your physiotherapist will match your treatment activities and intensity to your symptoms and educate you on appropriate use of the affected arm. Your therapist will carefully monitor your progress to ensure a safe healing procedure is followed.
Sometimes, conservative care cannot reduce the pain of adhesive capsulitis. In that case, your physiotherapist may refer you for an injection of a safe anti-inflammatory and pain-relieving medication. Research has shown that although these injections don’t provide longer-term benefits for range of motion and don’t shorten the duration of the condition, they do offer short-term pain reduction.
The focus of treatment during phase 3 is on the return of motion. Treatment may include:
Your physiotherapist may introduce more intense stretching techniques to encourage greater movement and flexibility.
Your physiotherapist may take your manual therapy to a higher level, encouraging the muscles and tissues to loosen up.
You may begin strengthening exercises targeting the shoulder area as well as your core muscles. Your home-exercise program will change to include these exercises.
In the final stage your physiotherapist will focus on the return of “normal” shoulder body mechanics and your return to normal, everyday, pain-free activities. Your treatment may include:
The stretching techniques in this stage will be similar to previous ones you’ve learned but will focus on the specific directions and positions that are limited for you.
Your physiotherapist may perform manual therapy techniques in very specific positions and ranges that are problematic for you. They will focus on eliminating the last of your limitations.
Your physiotherapist will prescribe specific strengthening exercises related to any weakness that you may have, to help you perform your work or recreational tasks.
Return to Work or Sport:
Your physiotherapist will address movements and tasks that are required in your daily and recreational life.
Can this Injury or Condition be Prevented?
The cause of adhesive capsulitis is debatable, with no definitive cause. Therefore, to date, there is no known method of prevention. The onset of the condition is usually gradual, with the disease process needing to “run its course.” However, the sooner you contact your physical therapist, the sooner you will receive appropriate information on how to address your symptoms most effectively.