By Michelle Louwagie; MSc PT Candidate 2022 McMaster University
What is it?
The exact physiology of adhesive capsulitis is not fully understood, but it is hypothesized that an inflammatory process takes place, resulting in fibrotic tissue and adhesions within the shoulder capsule, which leads to stiffness and pain. Typically, this condition affects women more than men, and those between the ages of 40 and 60 years.
There are two different types of adhesive capsulitis: primary and secondary.
- Primary (Idiopathic):
- No underlying cause or associated condition can be identified
- Develops gradually without a traumatic event occurring
- Secondary (Acquired)
- Occurs secondary to another condition (i.e. fracture, dislocation, rotator cuff repair, etc.)
Phases of Primary Adhesive Capsulitis
- Freezing:
- Shoulder pain and stiffness begins
- Tasks like reaching behind your back or for the top shelf in the cupboard may feel harder than it used to
- Pain feels achy and diffuse at rest, but is intensified with movement
- The shoulder feels worse at night, you may notice difficulties with sleeping, especially when lying on the affected side
- As the pain worsens, a loss of mobility becomes more prominent, especially at the end of your shoulder ranges
- Although the length of this stage can vary from patient to patient, it typically lasts 2-9 months
- Shoulder pain and stiffness begins
- Frozen:
- Pain is less severe in this stage, but you may feel like your shoulder is stuck or “frozen” with all directions of movement
- You may notice difficulties in carrying out daily tasks such as cooking, cleaning and bathing
- This stage tends to last about 4 to 12 months
- Thawing:
- Pain is no longer an issue and function is gradually restored
- This stage typically lasts 5 to 26 months in length
How does physiotherapy help?
Physiotherapy is a widely conservative treatment for adhesive capsulitis. Your physiotherapist will complete an assessment of the shoulder to gain insight into your available range of motion, strength and level of pain. With these findings they will be able to treat you accordingly in terms of which stage you are experiencing. Some techniques that may be used in treatment are use of heat and/or ice, range of motion exercises, joint mobilizations, stretching exercises, education for the patient, and home exercise programs. Generally, exercises become increasingly important in the thawing stage as range of motion is restored and the muscles in the shoulder are strengthened.
In some cases, physiotherapy may be used as an adjunct with other treatments such as pharmaceutical treatments or corticosteroid injections. There is evidence to show that corticosteroid injection into the joint capsule can decrease the fibrotic changes in a frozen shoulder, which may help to improve recovery time. Physiotherapists can work alongside physicians to decide whether or not you may be a candidate for a corticosteroid injection or other pharmaceutical treatments.
References:
1. Adhesive Capsulitis (Frozen Shoulder) - ClinicalKey [Internet]. [cited 2022 May 31]. Available from: https://www-clinicalkey-com.libaccess.lib.mcmaster.ca/#!/content/clinical_overview/67-s2.0-107b6bbf-8ff5-4a03-bd9d-4c8c3c22b127
2. Frozen Shoulder - Adhesive Capsulitis - OrthoInfo - AAOS [Internet]. [cited 2022 May 30]. Available from: https://www.orthoinfo.org/en/diseases--conditions/frozen-shoulder/
3. Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2013 May;43(5):A1–31.
4. Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. 7th ed. Philadelphia: F.A. Davis; 2018
5. Patel R, Urits I, Wolf J, Murthy A, Cornett EM, Jones MR, et al. A Comprehensive Update of Adhesive Capsulitis and Minimally Invasive Treatment Options. Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):91–107.
6. St Angelo JM, Fabiano SE. Adhesive Capsulitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 May 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532955/
7. Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World J Orthop. 2015 Mar 18;6(2):263–8.