Frozen Shoulder / Adhesive Capsulitis
People in their 50s are most mostly affected by frozen shoulder, a painful condition that can interfere with everyday activities and sleep. The condition is marked by discomfort and a significant reduction in the shoulder joint’s active and passive movements. Macroscopic observations show thickening and congestion of the capsule together with an inflammatory appearance of the coracohumeral and middle glenohumeral ligaments, especially around the rotator interval. It may develop as a result of a traumatic event that affected a shoulder joint, or an inflammatory condition(e.g.Inflammatory arthritis). In some cases it have been also seen that it can arise without presence of any particular condition. According to ki – choer et al, there have been linkages of other diseases with frozen shoulder and most common association is diabetes mellitus. The reported incidence with frozen shoulder ranges from 10% to 36%1.
Causes:
You may experience,
- Subtle beginnings of discomfort and immobility with or without any prior history of trauma, infection, or inflammation.
- Complain of shoulder pain that is poorly localized and is most uncomfortable at night while lying on the afflicted side.
- Restrictions of active and passive movements, firstly in shoulder joint external rotation and flexion in later stage 2.
Role of Physical therapy
Physical therapists use comprehensive approach that makes a path for accurate diagnosis for the frozen shoulder and its underlying causes. Targeted evaluation includes observation of posture and positioning, physical examination(e.g.Range of movement assessment, evaluation of shoulder joint ligaments), resisted muscle tests, special tests (e.g.shoulder shrug sign), this all-encompassing strategy creates a route for a precise diagnosis of frozen shoulder and its underlying causes.
Physical therapy is an important part of treatment for those with frozen shoulder, providing a number of advantages that help with recovery. It will lead to restoration of movements, reduction in pain and improvement in functional activities. During initial stage, the main priorities are treating your pain and ruling out any other possible reasons of your frozen shoulder. In this painful phase very gentle shoulder mobilization and muscle release techniques for pain reduction can help. It has been demonstrated that using a IFC unit can lessen discomfort. Hot packs and cold packs can be used during therapy. When combined with stretching, it can reduce muscle viscosity and promote neuromuscular mediated relaxation, which can enhance muscle extensibility and range of motion. Patients responded better to combination treatment, which included applying hot packs and cold packs before and after shoulder exercises, in a randomized research by Bal et all3. For a speedy return to function, gentle and targeted shoulder joint mobilization, stretches, muscle release methods, and exercises will rebuild your range and strength.
Ninety percent of the patients in a prospective research by Griggs et al. reported a positive outcome, demonstrating the effectiveness of a non-operative therapy using a four-direction shoulder stretching exercise regimen4.
Manual techniques and exercises will be planned according to different individuals and specific needs. Symptoms of pain and decreased range of movements will improve with these physical therapy plans, Levine et al. found that non-operative therapy was successful in 89.5% of ninety eight patients with frozen shoulder5. Numerous people have benefitted from physical therapy, according to reviewed research, and have shown improvements in their functional abilities, enhanced mobility, and/or decreased symptoms.
Ultimately, because physical therapy improves mobility, relieves discomfort, and strengthens the shoulder, it is an essential part of treating frozen shoulder. You can get long-lasting benefits and avoid further difficulties by adhering to an organized therapeutic plan.
References:
1. Cho, C. H., Bae, K. C., & Kim, D. H. (2019). Treatment strategy for frozen shoulder. Clinics in orthopedic surgery, 11(3), 249-257.
2. Pandey, V., & Madi, S. (2021). Clinical guidelines in the management of frozen shoulder: an update!. Indian journal of orthopaedics, 55(2), 299-309.
3. Bal, A., Eksioglu, E., Gulec, B., Aydog, E., Gurcay, E., & Cakci, A. (2008). Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation, 22(6), 503-512.
4. Brue, S., Valentin, A., Forssblad, M., Werner, S., Mikkelsen, C., & Cerulli, G. (2007). Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surgery, Sports Traumatology, Arthroscopy, 15(8), 1048-1054.
5. Kelley, M. J., Mcclure, P. W., & Leggin, B. G. (2009). Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of orthopaedic & sports physical therapy, 39(2), 135-148.
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