Codman introduced the term frozen shoulder in 1934 to describe patients who had painful loss of shoulder motion with normal radiographic studies. . Adhesive capsulitis is also known as periarthritis of shoulder & frozen shoulder. 

The peak age of onset was 54-59 years in both sexes. Over 40 % of the patients were referred to clinic after 6 month had elapsed from time of onset of the disease. 

The right shoulder was more frequently involved than the left, particularly in men. One shoulder was affected only in 75% of patients.

It is rare in children [11] and peaks between 40 and 70 years of age [10] women are often affected than men. Patient with adhesive capsulitis have a painful restriction of both active & passive glenohumeral joint motion in all planes


WHAT CAN CAUSE FROZEN SHOULDER?

Extended Immobilization

Surgical trauma esp. chest or breast wall procedures

Diabetes, 

Hyperthyroidism 

Heart Disease

Inflammatory arthritis and cervical spondylosis.


    SYMPTOMS:

Inability to sleep toward the affected side.

Dull achy pain in shoulder

Decreased range of motion

Local tenderness around shoulder joint


Symptoms of Frozen Shoulder can be finely understand in three stages

1. The "freezing" stage:

In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.

The "frozen" stage:

In this stage, pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts 2 to 6 months.

The "thawing" (recovery) stage:

In this stage, pain lessens, and ability to move the shoulder slowly improves. Full or near full recovery occurs as normal strength and motion return. The stage lasts 6 months to 2 years.


TEST FOR FROZEN SHOULDER

Conduct a physical exam of your arms and shoulders:

Therapist will move your shoulder in all directions to check the range of motion and if there is pain with movement. Therapist is moving your arm and not you,called determining your “passive range of motion.”

The doctor will also watch you move your shoulder to see your “active range of motion”. There will be incomplete range of Abduction, External rotation and Elevation. Pain will be in all movements.


OTHER INVESTIGATIONS

X-rays of the shoulder are also routinely obtained to make sure the cause of the symptoms is not due to another problem with the shoulder, such as arthritis. Advanced imaging tests, such as MRI and ultrasound, are usually not needed to diagnose frozen shoulder.


MANAGEMENT OF FROZEN SHOULDER

CONSERVATIVE TREATMENT: Placing an ice pack on your shoulder for 15 minutes at a time several times per day can help to decrease pain and inflammation.

MEDICATIONS: To treat the pain and reduce your joint inflammation, doctor may recommend an anti- inflammatory medication like aspirin, ibuprofen, or naproxen sodium. Intrarticular corticosteroid have the addictive effect of providing rapid pain relief, mainly in the first weeks of the exercises treatment period


PHYSIOTHERAPY: Physiotherapy proved to be very beneficial, if taken under the proper guidance.

Exercises and Interferential therapy can be of highly useful. 

Deep or superficial heat, trigger point physiotherapy 

Accessory joint mobilisation.

Isometric Strengthening exercises with deep stretches of affected muscles.


Some of the home exercises are designed for the ease of patients as follows:

 10 seconds holds with 5 second relax time. 15 sets within pain free range.

 

The anticipation of a solidified shoulder relies upon its reaction to active recuperation, activities, and medicines as depicted previously. Once more, it is fundamental to abstain from reinjuring the shoulder tissues during the restoration period. Prevention of a solidified shoulder includes maintaining a strategic distance from injury or reinjury to the shoulder.

Research and Contributed by: 


Dr Parul Gupta
( MPT ORTHO, MIAP)