Frozen Shoulder
Frozen shoulder or adhesive capsulitis is a condition that slowly limits shoulder active and passive motion. Frozen shoulder is split into primary and secondary. (1) Primary frozen shoulder does not have a known cause. Secondary frozen shoulder occurs following a period of restricted shoulder motion like a surgery or trauma. Frozen shoulder has 4 stages. (2,3)
Stage 1 is the “precursor” phase that has achiness that slowly becomes sharp at endrange.
Stage 2 is the painful freezing stage that has progressive loss in shoulder range of motion over weeks to months. Stage 3 is the frozen stage where there is significant loss of range of motion that persists for months and is painful to move beyond.
Stage 4 is the thawing stage that has progressive decreasing pain and stiffness. It can be up to nine months to regain functional range of motion.
Individuals with frozen shoulder typically have a gradual onset of pain and stiffness for which they cannot identify an origin. Pain is often felt around the insertion of the deltoid and is sharper at end ranges. Range of motion deficits start restricting reaching overhead, behind the back or to the side. This often leads to difficulties with dressing. Scapular dysfunction can have a significant impact on range of motion in frozen shoulder.
Treatment consists of working on the range of motion limitations. Joint manipulation is effective in the thoracic and cervical spine. Scapular mobilizations should also be done since scapular mobility directly connects to shoulder mobility. Any underlying functional deficits should also be treated.
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Lundberg BJ. The Frozen shoulder: clinical and radiographical observations the effect of manipulation under general anesthesia structure and glycosaminoglycan content of the joint capsule local bone metabolism. Acta Orthopaedica Scandinavica. 1969 Mar 1;40(sup119):1-59.
Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. The American journal of sports medicine. 2010 Nov;38(11):2346-56. Link
Pearsall AW et al. Adhesive Capsulitis.