Mississauga Chiropractor Presents: Frozen Shoulder

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Here’s another blog from a Mississauga Chiropractor…

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Frozen Shoulder or Adhesive Capsulitis is the marked reduction in shoulder range of motion due to soft tissue contracture around the glenohumeral joint.

 

4 Stages of Frozen Shoulder:

Stage

Clinical Description

1

Pre-adhesive   Stage: 

  •   Full or slightly limited range of motion
  •   No adhesions
  •   Painful abduction/external rotation at   glenohumeral joint
  •   Gradual onset of pain
  •   No stiffness

2

Acute Adhesive   Synovitis:

  •   Early adhesion formation in axillary fold
  •   Painful Arc – slight limitation in range
  •   Constant shoulder pain which may radiate
  •   Joint may begin to “seize up”

3

Maturation Stage:

  •   Less inflammation
  •   Moderate reduction of axillary fold
  •   Reduction in size of synovial cavity &   glenohumeral space
  •   No pain at rest
  •   Pain on motion
  •   Painful at the end of shoulder range of motion
  •   Muscle atrophy
  •   Decreased Range of motion
  •   Very Stiff

4

Chronic Stage:

  •   Shoulder capsule adhesions have fully matured
  •   Extreme loss in shoulder range of motion
  •   Marked decrease in the glenohumeral joint   cavity

 

Demographics:

a)      Age: 40-60 years old; there is a 3% chance of developing the condition in your lifetime

b)      Gender:  Females > Males

c)      Increased incidence is associated with coexisting diabetes (10%-20%)

d)      Often involves the non-dominant arm (occasionally bilateral)

e)      More common in sedentary people compared to manual labourers

 

History:

a)      Pain, then stiffness are the main complaints; there is a gradual onset; difficult to diagnose until it has reached stage 3-4

b)      Muscle atrophy

c)      Decreased shoulder range of motion – decrease shoulder abduction/external rotation and pain with all movements.

Management:

a)      Acute:

  1. Initially control pain and swelling
  2. Treat 3-5 days/week
  3. Avoid glenohumeral manipulation or other vigorous manual therapies with acute glenohumeral pain

 

b)      Post-acute:

  1. Ultrasound and hot packs
  2. Mobilizations and stretching (glenohumeral joint, scapulocostal region and back)
  • Ice first if treatment is too painful
  • If it is very painful, start the treatment slowly to gain trust and use extra care with fragile and older geriatric patients

c)      Follow the treatment with massage; use heat & ultrasound to calm the tender muscles;  manipulation or aggressive massage should be discontinued if signs & symptoms worsen

d)      Aggressive Home Exercise Program: (lots of stretching and active range of motion exercises)

  1. Start with pendulum arm swings (always use as a warm-up) – add weight as tolerated
  2. Wall Walks in flexion and abduction ranges
  3. Light tubing exercises and isometrics below 90 degrees (emphasize external rotation, flexion, & abduction)

 

Prognosis:

a)      Depends on the patient’s motivation and compliance

b)      May take 1 year or more (60% resolve within 2 years without treatment – results are not as good as with treatment) – progress is a slow, long-term, laborious process

 

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