Shoulder pain is one of the most common problems affecting the joints and muscles of the human body. It has been estimated that adhesive capsulitis or frozen shoulder accounts for a fifth of all physician visits for shoulder pain. Frozen shoulder is a condition where both active and passive range of movement at the shoulder in all directions becomes painful and increasingly stiff. For reasons that are uncertain, this condition is seen more frequently in females over the age of 40, and diabetics. The condition sometimes develops following a specific injury such as a fall, or following a surgery, but often occurs for no apparent reason. The cause for the painful condition is thought to initially be a severe inflammatory process in the capsule of the shoulder joint that gradually resolves and develops into excessive fibrosis or scarring of the joint capsule causing excessive motion loss and pain with shoulder movements. Frozen shoulder is thought to be self-limiting running a very slow protracted course than can last anywhere from 1-3 years. During this time it has been observed to have 3 distinct stages.
Stage 1 painful /freezing
constant pain with minimal to no motion loss that progress in intensity
Stage 2 stiff/frozen
increasing pain and stiffness that severely restricts arm use and disturbs sleep
Stage 3 recovery/thawing
reduced pain frequency and severity and slow resolution of shoulder stiffness.
Management of the patient with frozen shoulder is dependent on the stage of the condition. In the early stages where inflammation is the predominant cause of pain, medication such as NSAIDS (advil,alleve, IB profen, etc.) and/or steroid injections into the shoulder joint given by an experienced specialty physician is the treatment of choice. Later in the course of the disorder (late stage 2 or stage 3) when pain at rest has abated mechanical therapy under the guidance of an experienced physical therapist is very effective at resolving the mechanical pain caused by the excessive scarring that occurs in the joint capsule, ensuring full restoration of normal shoulder functions. Appropriate frequency and intensity of mechanical therapy is guided by the patient’s pain response. The primary mode of treatment is end range stretching exercises in various directions, but manual therapy techniques can be employed as complementary treatment if tolerated by the patient. In general the aim of the mechanical therapy is to decrease pain and restore movement by gradually and progressively stretching the abnormal capsular tissue in a way that does not create further trauma to the tissues, yet hastens the restoration of elasticity in the involved tissues. This is accomplished by frequently and repetitively producing or increasing the familiar pain but only while the therapy is being performed or for a very short while afterwards.
Kelley, M. J., McClure, P. W., & Leggin, B. G. (2009, February).
Frozen Shoulder: Evidence and a Proposed Model Guiding Rehabilitation. JOSPT, 39(2), 135-149.
Laslett, M. (1996). Mechanical Diagnosis and Therapy: The Upper Limb.
McKenzie, R., & May, S. (2000). The Human Extremities: Mechanical Diagnosis and Therapy. Wellington, New Zealand: Spinal Publications New Zealand Ltd.
McKenzie, R., Watson, G., & Lindsay, R. (2009). Treat Your Own Shoulder. Spinal Publications New Zealand Limited
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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