Mrs B was a 54 year old lady who presented to the clinic complaining of a 9 week history of left-sided shoulder pain and restricted movement. These symptoms started gradually but over time they began to affect her general quality of life and morale. Pain increased, particularly at night leaving her tired during the daytime and she started to experience problems manipulating her arm, especially when dressing.
We took a full history from Mrs B about her presenting symptoms and also recorded a detailed account of her previous medical and surgical history. During this process she related how she had gradually began to feel more and more lethargic over the previous few years and following some investigations she had been recently diagnosed with Hypothyroidism. She said that since going on Thyroxine she felt considerably better and so now was disappointed that her health was once again in question.
After conducting a thorough examination, which included assessment of active and passive range of movements (ROMs), we reached a diagnosis of Frozen Shoulder (Adhesive Capsulitis).
With the aid of diagrams we described what a frozen shoulder was and talked to Mrs B about treatment plans and expectations. During the discussion we outlined the three distinct phases (see below) of a Frozen Shoulder. We emphasised that early intervention was key to limiting the duration of the condition and therefore as her condition was relatively early we were optimistic that we would be able to demonstrate significant improvement.
We are pleased to report that after 8 treatments over a course of 3 months Mrs B has made a very good recovery. She is now completely pain free and has almost a full range of motion in his shoulder.
The term ‘Frozen Shoulder’ was first coined by an American Surgeon E.A. Codman back in 1934 and his definition is still widely respected, ‘this is a condition which comes on slowly with pain over the deltoid insertion, inability to sleep, painful incomplete elevation and external rotation, the restriction of movement being both active and passive, with a normal radiograph, the pain being very trying and yet all patients are able to continue their daily habits and routines’.
Its strongly associated with hyperthyroidism, hypothyroidism, hypoadrenalism, Parkinson’s disease, cardiac disease, pulmonary disease, stroke.
Adhesive capsulitis is classified into two categories: (1) primary, which is insidious & idiopathic (2) secondary, which is generally due to trauma or subsequent immobilization.
Adhesive capsulitis presentation is generally broken into three distinct stages.
As a general rule patients should have participated in some form of therapy for at least 2 months, and shown no progress.
Once a frozen shoulder is suspected, osteopathic treatment should be started as soon as possible, if the recovery time is to be shortened as much as possible. Medical opinion is that frozen shoulders typically take 18 – 24 months to recover if untreated.
Please feel free to call us at Cheadle Osteopathy (0161 478 1877) if you require clarification or further information.
Diagnosis and management of adhesive capsulitis.