Frozen Shoulder ( causes, symptoms, stages, physiotherapy management)

 WHAT IS FROZEN SHOULDER?

Frozen shoulder is a condition that affects the shoulder joint. It is also known as Adhesive Capsulitis. It is an inflammatory lesion of glenohumeral capsule leading to healing of contracture, results in loss of volume of joint. It usually involve pain and stiffness that develops gradually, get worse and then finally goes away. This can take from a year to 18 months or sometime 3 years.

The shoulder is made up of basically 3 bones, i.e. humerus, scapula and clavicle. There is also a tissue surrounding the shoulder which holds everything together means stabilises the shoulder joint and this is called Capsule.

In frozen shoulder, this capsule becomes so tight and thick that makes the shoulder movements very difficult.

STAGES OF FROZEN SHOULDER:-

1. FREEZING STAGE:-

   💧 All the AROM and PROM are painful at extreme of range and pain is elicited over pressure.

   💧 It slowly get worse over time and may hurt more at night.

   💧 This can last for approximately 6-9 months

2. FROZEN STAGE:-

   💧 Pain decreases in this stage but stiffness increases as there is adhesion formation and contracture of capsule.

   💧 Patient complaints of performing ADLs such as combing, dressing, reaching the back pocket.

   💧 This stage lasts for 4-12 months.

3. THAWING STAGE:-

   💧 Range of motion starts to go back to normal

   💧 This can take around 1 year to 18 months.

  

👉 Frozen shoulder is self-remitting condition in which the symptoms vanish completely in 18 months of time.

CLINICAL FEATURES OF FROZEN SHOULDER:-

👉 Patient complains of pain in the lateral brachial region (V of deltoid) refers to C₅ and C₆ segment.

👉 The pain describes by the patient is dull ache only on activities and on when you unconsciously lie on the same side.

👉 On physical examination the movement is restricted in Capsular pattern ( EXTERNAL ROTATION IS MORE LIMITED THAN ABDUCTION WHICH IS MORE LIMITED THAN INTERNAL ROTATION)

👉 Difficulty in performing BADLS and ADLS.

SPECIAL TESTS

SCARF TEST 

In this test, horizonal adduction and flexion are checked by asking the patient to reach superior border of opposite scapula from the front of the chest. If patient is not able to perform this, then the test is POSITIVE.

SHOULDER SHRUG SIGN

In this, the patient will not be able to lift the arm to 90 degree abduction without elevating the whole scapula or shoulder girdle. 

APLEY'S SCRATCH TEST

The patient is asked to touch the superior border of scapula by abduction and external rotation or by adduction and internal rotation.

MANAGEMENT OF FROZEN SHOULDER:- 

Patient education:- For treatment of frozen shoulder, patient education is very important in helping to reduce frustration and encourage compliance. It is also helpful to create Home Exercise Program which can treat the condition more early.

Physiotherapy management will depend upon the stage--

       1. ACUTE PHASE  

Relief of pain and spasm is the main focus of this stage, which is controlled by application of ice pack, ice massage, TENS.

During this stage, any activity that can cause pain should be avoided. Better results have been found in patients who performed simple pain free exercises, rather than intensive physical therapy.

A pulley may be used to assist range of motion, depending on patient's ability to tolerate the exercise.

Isometric strengthening of rotator cuff muscles, pendulum exercises are performed .

2. SUBACUTE PHASE

U.S is given to break the adhesion in capsule which is given into posteroinferior area.

Gentle and specific shoulder joint mobilisation and stretches are performed to regain range and strength of the joint.

Mobilisation with movement (MWM) appears to be most effective and more effective than stretching exercises alone.

Care must be taken not to introduce exercises that are too aggresive.

    👉 capsular stretches are performed (anterior , posterior and inferior stretches)

3. CHRONIC PHASE 

Strengthening exercise are also included along with the progression of all the above exercises.

The stretch can be held for longer duration and sessions per day can also be increased. 

Pulley and WAND exercises are also introduced in the treatment programme.

Home Exercise Program is given to the patient to reduce the chances of relapsing of the condition.