• Michael Liougas

Frozen Shoulder Treatment (Adhesive Capsulitis Program)

Updated: Nov 16, 2021

Patients that experience severely reduced mobility in the shoulder joint may be experiencing a condition referred to as a frozen shoulder. In these cases, a person will not be able to move the shoulder in almost any direction. This condition requires frozen shoulder treatment from an experienced physiotherapist.


What exactly is Adhesive Capsulitis or Frozen Shoulder?

A frozen shoulder is a term that physiotherapists refer to medically as Adhesive Capsulitis. The shoulder joint or glenohumeral joint is surrounded by a capsule that is comprised primarily of connective tissue that helps maintain the stability of the shoulder joint.


An image of the glenohumeral joint is the area that frozen shoulder physiotherapy targets improvement

Unfortunately with a frozen shoulder, the capsule becomes inflamed and thickened and causes the shoulder to be painful with certain movements. The classical sign that a patient may have adhesive capsulitis is the shoulder has reduced both active and passive range of motion specifically with horizontal abduction, reduced flexion and reduced external rotation. Many patients complain that the shoulder is painful at night while sleeping and experience disturbed sleep.


Causes of Adhesive Capsulitis or Frozen Shoulder

The true cause of adhesive capsulitis or frozen shoulder is not known for certain, however, evidence suggests that patients that may have had one of the following conditions or circumstances that may have triggered adhesive capsulitis, such as:

  1. A patient has had a shoulder restricted in a sling after a surgical procedure such as a mastectomy or fracture of the arm.

  2. A patient may have had prior or current tendinitis or tendinosis or partial thickness tear of the rotator cuff muscles of the shoulder.

Risk Factors

Data collected demonstrates that women are more prone than men to developing adhesive capsulitis, particularly over the age of 35 years of age.

complex shoulder muscles means many potential causes and symptom of frozen shoulder

Symptoms of Adhesive Capsulitis perceived by a patient

Patients often do not notice the initially slow and gradual onset of the early stages of adhesive capsulitis, and mild symptoms are often overlooked until a point in time, where patients experience challenges with performing regular day to day activities, such as putting a coat on or simply reaching to wash the top of the head. Patients often express that it is difficult to reach behind their back, such as hard to put on and off a bra strap or when finding it hard to put on a car seatbelt.


Underlying Conditions Associated with Adhesive Capsulitis

Diseases that have been linked with the formation of adhesive capsulitis may include a patient with diabetes, an overactive or under-active thyroid or underlying cardiovascular disease. Interestingly enough, patients with Parkinson’s disease and tuberculosis have also been linked to increasing the risk for the development of adhesive capsulitis.


Adhesive Capsulitis Classification

Adhesive Capsulitis has been classified in one of three stages, based on the clinical presentation. The length of time that a patient is categorized in each stage may range from a few weeks to months and in some cases a few years.

  1. The Freezing stage is usually when a patient begins to notice some shoulder discomfort and pain with overhead movements and with daily activities and minor loss of range of movement

  2. During the Frozen Stage, the pain is not too bad but it is clear that the shoulder range of movement is extremely reduced

  3. The Thawing stage is when a patient can notice an increase in shoulder active range of movement and is now able to perform more activities with greater ease.


Frozen shoulder therapy is needed for the area highlighted in red

Diagnosis

At our Davisville Village physiotherapy clinic our physiotherapists will perform an orthopedic examination or assessment to determine the stage and progression of the frozen shoulder by performing a series of movements.

  • A patient will be asked to move their shoulder actively in various planes of movement until the early onset of pain.

  • The physiotherapist will then perform the same movements while the patient is in a relaxed position.

  • The physiotherapist will take objective measurements with the use of a goniometer to determine the degree of loss of movement.

  • Our physiotherapists can diagnose a frozen shoulder with no need for any diagnostic imaging in the majority of cases.

  • A physiotherapist may however recommend additional diagnostic images such as x-rays, Diagnostic Ultrasound or Magnetic Resonance Imaging (MRI) if there appear to be any red flags or any other underlying condition.

Treatment at Global Health Physiotherapy Clinic

At Global Health Physiotherapy Clinic, our physiotherapists have extensive experience in treating patients presenting with reduced or loss of active range of motion and pain associated with adhesive capsulitis. Our evidence-based approach yields optimal results and patients often return to a pain-free lifestyle in under 3 months.


Depiction of extreme pain from Adhesive Capsulitis

Adhesive capsulitis could be quite painful to treat, and in some cases, a physiotherapist may recommend over-the-counter (OTC) pain medications such as ASA (Aspirin) Advil or Aleve. If these over-the-counter medications do not reduce the pain enough to allow completion of the physiotherapy treatment session, a physician may be able to prescribe a stronger pain-relieving drug such as Naproxen.

  • At the initial stages of physiotherapy treatment of adhesive capsulitis, our physiotherapists will primarily focus on reducing the inflammation and pain of the capsule with the use of Ultrasound and cold compress.

  • Our Physiotherapists are certified to perform mobilizations of the shoulder joint to improve the arthro-kinematic movements and overall active movement of the shoulder joint.

  • Our physiotherapists will educate and demonstrate to the patient the specific active exercises to help increase the movement.

Successful results are directly related to patient adherence to the Adhesive Capsulitis Program by performing the customized home exercise program regularly, to reach optimal results in the shortest time possible.

The majority of patients do quite well with conservative physiotherapy treatments of Adhesive Capsulitis. Patients are discharged from the Adhesive Capsulitis Program, ranging from 8 weeks to 16 weeks based on numerous factors.


Patient receiving frozen shoulder treatment

In some instances, if patient progress is not in line with our expectations, our physiotherapists will immediately contact the patient’s family physician to review alternative or complementary treatment such as a steroid injection(s).

In rare instances, if conservative treatments do not elicit satisfactory results, a family physician may recommend that patient speak with an orthopedic surgeon to perform joint distension, shoulder manipulation under general anesthesia or surgical arthroscopic procedure.


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