Frozen Shoulder (Part 1 of 4) – adhesive capsulitis

Frozen shoulder (Adhesive Capsulitis) is a common condition seen in about 3-5% of the general population. It generally occurs in people over the age of 40 years and is seen far more often in women than in men. It generally occurs spontaneously without any trauma, but can also occur after a significant traumatic event such as a fall, fracture, dislocation and sometimes after surgery. There is also a known association between frozen shoulder and people with Diabetes, as it is believed that excess glucose impacts the collagen in the shoulder. It has been estimated to affect about 20% of people with Diabetes.

 

This condition causes shoulder immobility (hence frozen shoulder) as well as pain with movements of the arm, and particularly at night. The lining of the shoulder (the capsule) becomes inflamed and contracted and the condition can occur in both shoulders in approximately 10% of people. Once the condition settles it rarely recurs. While the terms freezing, frozen and thawing are used there is no obvious change in temperature of the shoulder through the course of the condition.Frozen shoulder

 

There are 3 distinct phases of the frozen shoulder:

1. In the “freezing” stage, which may last from 6 weeks to 9 months, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion.
2. The “frozen” stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts 4 to 9 months.
3. The “thawing” stage is during which the shoulder motion slowly returns toward normal. This stage generally lasts 5 to 26 months.

 

The condition usually resolves without any treatment and in primarily time dependent, but may sometimes require analgesia, physiotherapy and intra-articular corticosteroid or local anaesthetic. Surgery is generally reserved for ‘resistant cases or functionally compromised patients’ and may involve manipulation under anaesthesia, and arthroscopic or open release.

 

The further parts of this series of injury management advises will look at the efficacy of conservative treatment and medical and surgical management.
 

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Ref: Treatment of frozen shoulder by manipulation under anaesthetic and injection: Does the timing of treatment affect the outcome? Thomas WJC, Jenkins EF, Owen JM, Sangster MJ, Kirubanandan, Beyon C, Woods DA. The Journal of Bone & Joint Surgery, October 2011.

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

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