How To Get Rid Of Adhesive Capsulitis?

A 50-year-old lady who presented to the clinic complaining of a 6 week history of left-sided shoulder pain and restricted movement. These symptoms started insidious onset but over time they began to affect her daily life style. Pain aggravate, particularly the pain worsens at night, sometimes disrupting sleep and she started to experience problems to dress up clothes, can’t wash her face , hair or brush her teeth (with the arm involved), can’t get her hand to her face, can’t put a shirt overhead, she struggle to tuck herself in if wearing jeans or skirts. She can’t lift things, can’t move her arm more than a few inches in any direction.

I took a full history from my patient about her presenting symptoms and also her previous medical and surgical history. While this process she corresponded how she had moderately began to feel more sluggish over the past few weeks.

After doing the evaluation of my patient with shoulder dysfunction, that included assessment of active and passive range of motion (ROMs), other physical examination and some different maneuver techniques. These maneuver are also very useful to diagnosed frozen shoulder. By this examination, its identified frozen shoulder. Thus I diagnosis her this is Adhesive Capsulitis.

Later than I conducted a session with my patient and communicate her and described about frozen shoulder and there precautions. Take her in my confidence then tell her about my treatment protocols. I highlighted that advanced intervention was key to assign the duration of the frozen shoulder and therefore as her condition was comparatively initial stage. I am very positive that I would be able to clarify considerable improvement.

I am pleased to address that after 3 months of treatment session. My patient has made a very good speedy recovery. Now she is completely pain relief and has nearly attain full range of motion in her affected shoulder.

So now on, I will discuss about the beneficial information regarding to frozen shoulder.  

What is Frozen Shoulder?

What exactly happened with our shoulder? Well, the word FROZEN telling its meaning by itself.

Frozen Shoulder Is medically term as Adhesive Capsulitis. It was first coined by an American Surgeon E.A. Codman back in 1934. Adhesive Capsulitis is a painful, stiffness and disabling disorder. In which shoulder capsule and connective tissue surrounding the glenohumeral joint.  When shoulder capsule become thick, stiff, and inflamed that may lead to restrict or limits the range of movement of your shoulder and causing chronic pain.

frozen shoulder most commonly strikes at the  age between 40 to 60 years of people.

Causes of Frozen Shoulder?

Any injury to the shoulder that result in scarring, thickening and shrinkage of joint capsule leads to frozen shoulder. Sometimes caused by lack of use due to pain but also often arises idiopathically. The more frequently occur in patients with risk factors of diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobilisation of the shoulder joint can be at risk to develop a frozen shoulder. After shoulder trauma or surgery.

Sign and Symptoms of Frozen Shoulder?

v Pain and persistent stiffness in the shoulder joint are the two main symptoms of a frozen shoulder. This makes it painful and limits the full range of normal shoulder movements.

v  The hallmark signs of a frozen shoulder is a pain and loss of movement  that may start very suddenly.

v The symptoms typically associated with three stages.

1.   Phase one is the freezing or painful phase. This stage mostly lasts for  2-9 months. Pain is the  initial  symptom, then rigidity and constraint  in movement also slowly increased. The pain gets worsen at night and keep you  awake, if you lie on  affected side of  shoulder.

2.   Phase two is the frozen or adhesive phase. This stage mostly lasts for 4-12 months. Pain usually diminishes but stiffness in movement remain and can gets worse by the time. In this stage of frozen shoulder all the movements are affected,  most severely affected movement is external rotation. Shoulder range of motion reduced due to immobilization of shoulder.

3.   Phase three is the thawing or  recovery phase. This stage usually lasts between one and three years. The pain is subsides and stiffness progressively  goes away and range of motion returns to normal, or near normal.

How is Frozen Shoulder Diagnosed?

Frozen shoulder can be diagnose from clinical sign and symptoms.

In some cases, X-rays and MRI must be performed to rule out what exactly happened to shoulder joint.   

One of the best way to diagnosed frozen shoulder is physical examination. In this physiotherapy play a  best role.

As we discussed this in above, how I took information from my  patient.

Treatment of Frozen Shoulder.

Based on three protocols medication , surgical therapy and physical  therapy.

Now here comes one of the most important part of treatment, basically what protocols should be used for rehabilitation of frozen shoulder?

Yes  start up plan always  initiate with Medication!

Every treatment starts with medications  cause its help to reduce pain and swelling  . Doctors mostly prescribes medicines  such as Non Steroid Anti Inflammatory Drugs. And if its severe then corticosteroid injection is give to person. Along with this heat should be apply on affected area. Stretching , icing and Physical therapy helps to increase the range of motion , flexibility and strength of shoulder.

If the conservative  treatment will not rule out, then Surgery is sometimes help to released the tightened tissue around the shoulder joint. Two kind of surgeries mostly done manipulation under anaesthesia, MUA (Manipulation under anaesthesia)is a procedure where patient is anaesthetised then physician arm is moved into positions that stretch the tight tissue. 

The other surgery uses  is shoulder arthroscopy, In this procedure surgeon insert tiny camera called arthroscope that inspects all the surrounding  tissues of  shoulder. And make a cut through tight tissues and scar tissue. These surgeries can both be done at the same time.

Physical therapy:

Treatment of patient depends on what stage of frozen shoulder he/she is suffering from? Keep in mind! we always have to match up the sign and symptoms with the correct treatment for that cause of frozen shoulder.

After evaluation of physical assessment of patient, we designed a treatment session based on condition and stage of patient.

Patient coordination and cooperation valued a lot in treatment session.

Rehabilitation For Freezing Stage:

Pain relieving techniques includes,

o  Muscle releases acupuncture.

o  Dry needling.

o  Gentle shoulder mobilisation.

o  Muscle releasing exercises.

o  Kinesiology taping.

When pain is unbearable intracapsular corticosteroid injection is  considered.

Rehabilitation For Frozen Stage:

o  Shoulder joint mobilisation.

o  Stretching exercises.

o  Muscle releasing techniques.

o  Acupuncture.

o  Dry needling.

Rehabilitation For Thawing Stage:

o  Shoulder mobilisation and stretching exercises are best to gain full shoulder range of motion.

o  Muscle strengthening exercises.