Frozen shoulder (FS) also called as adhesive capsulitis is a common shoulder condition in which there is adhesion formation of the shoulder joint capsule with a chronic inflammatory response. There is a limitation in range of motion of the shoulder joint, both active and passive range of motion (ROM) of the glenohumeral joint along with pain.
The “frozen shoulder” was initially called as “per arthritis. There is thickening and contraction of the capsule which becomes adherent to the humeral head” and therefore called as, “adhesive capsulitis
Main signs and Symptoms are pain, stiffness, and limited function and movement of the glenohumeral joint
Patients typically describe onset of gradual shoulder pain followed by a progressive loss of motion. The most common range of motion which mostly limited are flexion, abduction, and external rotation
Idiopathic (“primary”) adhesive capsulitis occurs on its own without a specific cause.
Secondary adhesive capsulitis occurs either after a shoulder injury any surgical procedure.
Frozen shoulder may also mimic other clinical syndromes; therefore, it is important to rule out other pathologies and to have an accurate differential diagnosis.
If appropriate conservative management is given in the acute pain stage adhesive capsulitis is thought to be reversible in the acute pain stage. In addition to the adherence of the capsule, shoulder complex muscle imbalances also contributes to altered shoulder motion. The upper trapezius tends to be more activated than the lower trapezius, creating an imbalance of the scapular stabilizers leading to increased elevation and upward rotation of the scapula during elevation of the glenohumeral joint. Therefore, inhibition of the upper trapezius can be done by KT taping. During glenohumeral joint elevation Because of its upward rotation of scapula prior to 60 degrees of abduction. Patients with adhesive capsulitis eventually develop the characteristic “shrug sign”, Patients with adhesive capsulitis may also develop compensatory postural adaptation such as rounded shoulders or increased thoracic curvature. Postural correction for the upper thorax and the interscapular muscles should also be done in addition to the manual techniques and mobilization.
CONSERVATIVE TREATMENT
Conservative treatment includes the following options depending upon the stage and symptoms of patient .These are medication, local steroid injection, physiotherapy, manipulation under anaesthesia, arthroscopic capsular release, and open capsular release. In majority of cases conservative management leads to improvement.
After 3 to 6 months of conservative trial of treatment if there is no symptomatic improvement then patient is advised to have an intraarticular injection. Although manual therapy and mobilization followed after the intra steroid inj gives better results in patients with gross loss of ranges and movement.as the intra steroid inj reduces the inflammation and adhesions in the shoulder joint and it gives the therapist a window period to gain the ranges.
It is important to note the phase being treated because of differences in symptoms at each phase varies.
In freezing phase, pain is most prominent. Steroid injection provides rapid pain relief, followed by manual therapy including shoulder mobilization, MET (muscle energy techniques), and the most important point is the active involvement of the patient is as the range gained by the therapist should be maintained by the patient himself by doing regular exercises taught to him.
In frozen phase, pain gradually subsides but restricted ROM is the main complaint of patients. In this phase, main aim of the therapy should be to increase the ROM, by using mobilization techniques, muscle and capsular releases with exercises and dry needling
In the thawing phase, there is barely any pain and progressive improvement in ROM.
Scapular mobilization plays an important role, as pain and muscular inhibition result in compensatory movements of the scapula. Therefore, the role of scapular motion is an important component in managing rehabilitation in FS,
Adhesive capsulitis has been regarded as a self-limiting condition However, this condition can sometimes last for years T.his long period of pain and disability deprive the patients of their routine life and activities of daily living. Although appropriate treatment is needed for a rapid return to their own life, combination of management strategies works well in rapid relief of frozen shoulder..
PHYSICAL THERAPY INTERVENTIONS
Gentle and pain free pendular and active exercises are better than intensive passive stretching and manipulation up to and beyond the pain threshold. Unfortunately, even after successful treatment few of the shoulder patients often have some deficiencies in range of motion
Non-aggressive physical therapy interventions like modalities, manual techniques, and therapeutic exercise are generally more effective than aggressive or intensive interventions.
Modalities.
Use of, transcutaneous electrical stimulation (TENS) has been shown to significantly increase range of motion and manipulation. In comparison to the use of modalities such as ultrasound, massage, iontophoresis, and phonophoresis in treatment of patients with adhesive capsulitis.
Passive Motion.
Manual Techniques.
Joint mobilization is quite effective for adhesive capsulitis. In particular, posterior glide mobilization is quite effective than anterior glide for improving external rotation. Along with this mobilization with distraction at end range of abduction and external rotation using either an anterior or posterior linear translation. Moreover, high-grade joint mobilization techniques were more effective than low-grade mobilization in head of humerus mobility
Myofascial trigger points, are sometimes present in the musculature around the shoulder. The subscapularis muscle in the main culprit for the “Frozen Shoulder” muscle because trigger points in the subscapularis leads to limited shoulder elevation and external rotation.Releasing the trigger points for the subscapularis and latissimus dorsi by MET may be effective at reducing irritation, pain, and helping to lengthen tight muscles.
Soft Tissue Mobilization.
Soft tissue mobilization and deep friction massage may help in relasing the pain associated with adhesive capsulitis. Instrument-assisted soft tissue mobilization (IASTM) has become increasingly popular in physical therapy practice.
In conclusion it’s not difficult to get rid of Frozen shoulder, only thing we require is compliance for the treatment and active participation of the patient in the exercise plan.
