Frozen Shoulder

Frozen Shoulder, referred to medically as Adhesive Capsulitis, is a condition in which the shoulder capsule ( a thick band of fibrous connective tissue) becomes inflamed and thickened over a period of time. This leads to pain and a loss of motion. There are a few major risk factors for the development of frozen shoulder and the reason for some of these risk factors is still unknown. Frozen shoulder is more prevalent in those who have diabetes or a thyroid disorder, in women who are aged 40-65, in those who have a history of frozen shoulder in the other arm, or those who have recently been immobilized in a sling. 

​

Frozen shoulder will progress through 4 different stages with the entire course taking between 12-18 months or sometimes longer to resolve. The first stage is the first three months. During this time sharp shoulder pain begins to develop at end ranges and achy pain develops at rest that can interfere with sleep. During this time diagnosis can be tricky because it can often mimic other pathology within the shoulder. Stage 2 is the freezing stage. During this stage loss of motion begins in all directions due to exacerbation of pain. Stage 3 is known as the frozen stage where the capsule calcifies and becomes fibrotic. Pain can persist but now motion becomes limited in all directions due to tightness and blocking. Finally stage 4 is the thawing stage. During this time the capsule thaws and begins to loosen again but significant stiffness remains. 

​

Treatment of frozen shoulder can be difficult in physical therapy. Often times people will seek physical therapy for frozen shoulder to address their limitations to range of motion and pain. And we can treat frozen shoulder in therapy but the truth is the shoulder may need some help outside of therapy to see improvements. Without any outside help we cannot really achieve improvements until the shoulder reaches the thawing stage. If the shoulder is in stages 1-3 as described above we can treat it an infinite amount of times and it will remain the same. With that being said a corticosteroid injection in conjunction with therapy can often help the patient find short term relief of pain (4-6 weeks) and an improvement to their function. Patients may also choose to undergo a shoulder arthroscopic capsular release procedure. In this procedure a radio-frequency probe is inserted into the shoulder and the probe uses radio frequency waves to cut the tissue capsule that surrounds the shoulder joint. This ultimately allows the shoulder to move more freely. People tend to have good results following this procedure and it can help prevent long term loss of functionality associated with frozen shoulder. For those who undergo this procedure or those that do not and still wish to receive therapy, physical therapy focuses on improving the mobility of the shoulder joint, loosening the joint capsule through soft tissue and dry needling techniques, and using exercises that work to help restore range of motion and strength in the shoulder. Please see the pictures below for examples of techniques we use to treat frozen shoulder. If you would like to schedule an appointment please reach out to us.