Shoulder pain is a very common affliction, some sources state that its prevalence affects up to 50% of people across their lifespan. Shoulder pain can limit a person’s mobility and functional performance. There are various causes of shoulder pain and one that can be particularly challenging is Frozen Shoulder. Frozen shoulder, also known and adhesive capsulitis or periarthrits, is a condition that is characterized by dense adhesions, capsular thickening, and capsular restrictions rather than arthritic changes in the cartilage or bones within a joint. This condition primarily affects people within the ages of 40 to 65 years and individuals with diabetes mellitus or thyroid disease. There are two ways that this condition occurs. The first being primary frozen shoulder which has no known cause and tends to gradual and subtle. Primary frozen shoulder may be triggered by chronic inflammation of soft tissue surrounding the joint such as the rotator cuff, biceps tendon or even the joint capsule. The second, or secondary frozen shoulder tends to result from periods of pain or restricted motions which include both rheumatoid and osteoarthritis, trauma, or even immobilization.
There are four stages of Frozen Shoulder. The affected tissues, limitations and treatment vary with each stage. Stage 1 (Onset): This stage is characterized by a gradual onset of pain that increases with movement and has a tendency to be present at night. This stage typically lasts up to 3 months. Stage 2 (Freezing): This stage consists of persistent and more intense pain, even at rest. Movement is limited in all directions and cannot be restored with injections. The duration of this stage is typically between 3 and 9 months after onset. Stage 3 (Frozen): This stage is characterized by pain only with movement, significant adhesions, and limited shoulder mobility. However, excessive scapular movement is a typical compensation. Another common presentation includes atrophy of the deltoid, rotator cuff, biceps and triceps muscles. This stage typically occurs between 9 and 15 months after onset. Stage 4 (Thawing): This final stage consists of minimal pain with no inflammation of the joint capsule. Capsular restrictions are still significant during this stage, but motion may gradually return. This stage lasts from 15 to 24 months after onset and some patients may never regain their normal range of motion.
Physical Therapy can be helpful to retain a person’s shoulder mobility and allow for a reduced duration of frozen shoulder with improved outcomes. Physical Therapy can provide proper education and initial exercises to help prevent or slow the onset of frozen shoulder, or provide progressive exercises and therapies to help reduce the duration. Each exercise is specifically tailored to each individual’s specific needs no matter which stage they may be in.
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