Frozen Shoulder and Physical Therapy- By: Jeffrey Williams PT, Cert MDT

Frozen shoulder or Adhesive Capsulitis, is a common diagnosis seen by physical therapists. It is believed to be caused by inflammation of the joint lining of the shoulder which causes scar tissue formation to form. This scar tissue prevents normal motion of the shoulder. Why this inflammation occurs is not completely understood. Studies have shown that people with diabetes are more likely to have this disorder. It has also been seen that 10% of patients with this had previous rotator cuff issues. People who have had issues resulting in keeping the shoulder immobile or people who have repetitive job requirements are thought to be more apt to have this. It has been found that 70% of patients are female and 70% are between the ages of 40-60 years old. The truth, however, is most patients who have this have no mechanism of injury that they can recall. The condition is serious. The patient can have debilitating pain and loss of function and the condition, if left untreated, can be permanent. The shoulder joint is the most dynamic joint in the body, with greater range of motion in more directions than any other joint in the human body. When that movement is lost or decreased, many activities we take for granted are no longer possible. Fortunately, 90% of cases can be resolved without surgery. 

Frozen shoulder generally progresses in three different stages: 

1. Stage 1 usually involves a slow onset of pain usually with specific movements only. The condition is “annoying” but the patient generally can easily modify behavior to avoid the ranges that bother them. The pain progressively worsens to the point where it is felt at rest and starts to affect sleep with lying on the affected side becoming difficult. The patient typically continues to avoid using the shoulder which results in even greater stiffness and pain. The literature varies but this stage is thought to last 2-9 months. Patients do not typically seek treatment during this stage. 

2. Stage 2 involves pain becoming more localized but may actually decrease in some cases as inflammation wanes. Function, however, is usually severely impaired as the scar tissue is at its most advanced stage leading to range of motion deficits in all directions. This is definitely the “frozen”

stage of the condition. Patients can experience up to a 50% loss of active range of motion making most functional activities with that arm nearly impossible. The patient likely can’t reach overhead or reach behind them to fasten a bra or put on a seat belt. Attempts to move the arm usually result in a high degree of discomfort. Again, this condition is different for everyone, but this stage can last 2-12 months without treatment.. 

3. Stage 3 involves the gradual loosening of scar tissue with resultant decrease in pain. Internal rotation, which would be fastening a bra or tucking in a shirt, is usually the last motion to come back. This stage can take up 24 months in worst case scenarios, again, without treatment 

Patients have many options to treat this condition. Many use anti-inflammatory meds or have joint injections to help with pain but physical therapy is the cornerstone to recovery. Physical therapy intervention has been found to do the most to speed the recovery of this disorder. Early intervention shows even greater success rates. Stretching and strengthening programs can easily be adapted for home use as well. In fact, patient participation is critical for this diagnosis. It is completely patient dependent. Many patients are fearful to start physical therapy for this as they fear that it will hurt. Our physical therapists will show you how to do the program to the point of “tension” not pain to ensure that your experience is positive. 

If you have any questions about frozen shoulder (adhesive capsulitis) and wish to speak to a physical therapist, give us a call at Advanced Rehabilitation. .