Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that leads to shoulder pain and stiffness. It affects approximately 2% to 5% of the population, with the highest prevalence in individuals aged 40 to 60 years. This condition is particularly more common in women, affecting about 70% of cases (Sheridan et al. 2006).

Frozen shoulder occurs when the shoulder joint capsule contracts and thickens significantly. The capsule, which normally measures around 1mm, thickens to about 5mm, leading to a loss of space in the joint. This contraction also reduces the amount of synovial fluid, which is responsible for lubricating the joint. Scar tissue forms within the joint, leading to pain and restricted movement. This results in a reduced range of motion in the shoulder joint.

Potential Causes of Frozen Shoulder

Despite its prevalence, the exact cause of frozen shoulder remains unclear. Several health conditions have been associated with an increased risk of developing this condition, including:

• Diabetes
• Cardiovascular disease
• Thyroid disorders (both hyperthyroidism and hypothyroidism)

Though various hypotheses exist, the research community has not reached a definitive conclusion on the exact cause of frozen shoulder.

Symptoms of Frozen Shoulder

Frozen shoulder is often mistaken for a rotator cuff injury due to the similarity in symptoms. However, frozen shoulder follows a distinct pattern of progression, which typically includes:

• Dull shoulder pain, which may sometimes radiate to the upper arm
• Loss of shoulder function and mobility, leading to difficulty moving the arm or performing everyday tasks

The condition typically progresses in three stages: freezing (painful), frozen (stiff), and thawing (recovery), with pain being more prominent in the early stages and stiffness in the later stages.

How Can Physiotherapy Help Manage Frozen Shoulder?

Physiotherapy has been shown to be highly effective in managing and improving the long-term outcomes of frozen shoulder. A well-structured physiotherapy program can focus on:

1. Reduction of Shoulder Pain: Physiotherapists employ techniques such as modalities (e.g., heat/cold therapy) and manual therapy to relieve pain and reduce inflammation in the shoulder.
2. Facilitation of Tissue Repair: By stimulating healing, physiotherapists help in repairing the tissues damaged by scar tissue formation.
3. Restoration of Normal Joint Range of Motion (ROM): Specialized stretching and mobilization techniques are used to regain movement in the shoulder joint and restore flexibility.
4. Strengthening of Muscles: Physiotherapists design exercises to restore the muscle length, strength, and movement patterns, which helps the shoulder function better and reduces strain.
5. Normalizing Upper Limb Neurodynamics: Nerve mobilization exercises can help restore normal nerve function around the shoulder joint, improving overall mobility.
6. Improving Shoulder Joint Function: Physiotherapy aims to normalize the shoulder’s function, enhancing movement in daily activities and improving overall shoulder health.