Frozen Shoulder (Adhesive Capsulitis)
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.
Useful information about a Frozen Shoulder (Adhesive Capsulitis)
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’.
- It usually affects the non-dominant shoulder although it can occur in either shoulder.
- Shoulder pain; usually a dull, aching pain.
- Limited movement of the shoulder.
- Difficulty with activities such as brushing hair, putting on shirts/bras.
- Pain when trying to sleep on the affected shoulder.
Who does it affect?
- Incidence of 3–5% in the general population.
- 2:1 Woman to Men.
- Affects approximately 2% of the general adult population aged between 40 and 60 years.
- Up to 20% in those with diabetes. This disorder is one of the – – Self-limiting disorder that resolves in 1–3 years.
What is associated with:
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.
- First stage is called the freezing or painful stage. Patients may not present during this stage because they think that eventually the pain will resolve. As the pain worsens and both active and passive ROM becomes more restricted, eventually the patient seeks medical consultation. This phase typically lasts between 3 and 9 months.
- During the second stage shoulder pain does not necessarily worsen. This stage lasts anywhere 4 to 12 months. The common capsular pattern of limitation has historically been described as diminishing motions with external shoulder rotation being the most limited.
- The third stage begins when ROM begins to improve. Its often referred to as the thawing stage and lasts anywhere from 12 to 42 months.
- Intra-articular corticosteroid injections.
- Capsular distension injections – The joint is injected to its limits with local anaesthetic to attempt to stretch the capsule. This technique is often poorly tolerated because of pain that is experienced during the process.
As a general rule patients should have participated in some form of therapy for at least 2 months, and shown no progress.
- Manipulation under anaesthesia as a means of treatment has been advocated. This method allows return of ROM in the operating room but leads to a very painful recovery.
- Arthroscopic release and repair Arthroscopy is an excellent additional tool for addressing the shoulder with adhesive capsulitis, and has become well accepted in treating this process.
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.