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by Dr. Dillon Cuppusamy

“Frozen shoulder”, also known as Adhesive Capsulitis, is a condition we see regularly that is characterized by stiffness of the shoulder, reduced range of motion and associated pain in specific shoulder/arm movements. The shoulder capsule often thickens and tightens, with a reduction in the synovial fluid that surrounds and lubricates the joint capsule.

While the medical world is at odds as to the cause of this condition, some have speculated that pre-existing conditions such as Diabetes or Thyroid pathology increase the incidence of frozen shoulders, while others have documented instances of immobilization after surgery.

Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. It’s unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder. Your doctor may suspect frozen shoulder if a physical exam reveals limited shoulder movement. An X-ray may be done to see whether symptoms are from another condition such as arthritis or a broken bone.

Stages of frozen shoulder:

  • Freezing

In the “freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

  • Frozen

Painful symptoms may improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.

  • Thawing

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

How is it treated?

Treatment for a frozen shoulder usually starts with nonsteroidal anti-inflammatory drugs (NSAIDs) and application of heat to the affected area, followed by gentle stretching. Ice and medicines (including corticosteroid injections) may also be used to reduce pain and swelling.

Here at InTouch, physical therapy increases your range of motion by means of specific exercises and manual therapy. A frozen shoulder can take a year or more to get better. Although uncommon, a frozen shoulder can recur, especially if a contributing factor like diabetes is still present.

Gentle, progressive range-of-motion exercises, stretching, and using your shoulder more may help prevent frozen shoulder after surgery or an injury. Experts don’t know what causes some cases of frozen shoulder, and it may not be possible to prevent these. But be patient and follow your doctor’s advice. Frozen shoulder nearly always gets better over time.

A study published in Archives of Physical Medical Rehabilitation found that mobilization (chiropractic or physio-therapeutic/Maitland) “techniques have beneficial effects in patients with primary AC of the shoulder.”  

Noten, S., Meeus, M., Stassijns, G., Van Glabbeek, F., Verborgt, O., Struyf, F. 2016. Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review. Archives of Physical Medical Rehabilitation. 97(5):815-25.

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