Adhesive Capsulitis, more commonly known as Frozen Shoulder, occurs due to stiffening of the shoulder due to scar tissue build up on the joint capsule. Patients commonly experience pain and severe loss of range of motion. Frozen shoulder affects 2-5% of the American population and it’s estimated 20-30% will also get it in the other shoulder. It more commonly affects women, patients are usually between 40 and 60 years old, and 10-20% have diabetes mellitus.

The cause of frozen shoulder is unknown, but there are many theories as to what causes it including:

-Inflammation of the lining of the joint (synovitis)

-Autoimmune reaction where the body “attacks” itself

-Reactions after an injury or surgery

-Pain from other shoulder conditions which causes them to stop moving their shoulder

-Prolonged immobilization

There are three stages of frozen shoulder with each stage varying in duration, pain severity, and range of motion and function loss. The initial stage is the Freezing Stage which is sometimes further broken down into the Prefreezing and Freezing Stage, the middle stage is the Frozen Stage, and the final stage is the Thawing Stage. The initial Freezing Stage can last up to nine months with a progressive loss of motion and increasing pain. During the Frozen Stage, the patient has usually had symptoms for 9-14 months and at this point has significant loss of motion and initially quite a bit of pain which lessen as the stage progresses. By the final Thawing Stage, they’ve been experiencing symptoms for 12-15 months, but will note significant decrease of pain and are having less range of motion limitations.

Current research and clinical best practice include a thorough course of physical therapy and cortisone injections with motion and functional use of the shoulder restored in one year or less. If patients don’t seek out any treatment for their frozen shoulder, it will usually run its course in about two years. It’s important to be upfront and honest with the patient that they’re in it for the long haul and to stress the importance of being compliant with their home exercise program to help regain motion and manage pain.

Physical therapy treatment is tailored to address the patient’s symptoms depending on which stage they are currently in. During the Freezing Stage, the focus is to try and maintain as much range of motion as possible and manage pain. It’s important with the home stretching program to not overdo it and be too aggressive because that can result in increased pain. In the Frozen Stage, the focus is on trying to regain the lost motion and will be much more aggressive with stretching and hands-on manual stretching and joint mobilizations. Once the patient is having improvements in range of motion and has moved into the final Thawing Stage, PT focuses on returning the shoulder to “normal” and regaining the appropriate shoulder mechanics and strength with performing daily activities.

If you are interested in learning more or about treatment options, don’t hesitate to call/text 701-318-4731 or email connectptnd@gmail.com to learn how we can help. Don’t forget to follow on Facebook and Instagram to stay up to date on the happenings at Connect Physical Therapy.

- Alison Fuhrman, PT, DPT, CMPT, OCS