Frozen Shoulder

“Adhesive Capsulitis aka Frozen Shoulder” by Kevin Andrews D.C.

Adhesive Capsulitis, also known as frozen shoulder, and periarthritis is a condition characterized by pain and stiffness in the glenohumeral joint.  It is also commonly associated with a decreased range of motion in all directions of the glenohumeral joint. This condition often demonstrates a negative cascade effect because when the shoulder is in pain, patients tend to move the shoulder less, and this leads to less range of motion and so on. (MayoClinic)

Some common characteristics of a patient with adhesive capsulitis include, but are not limited to: any person over the age of 40, and is more common in people with diabetes.  Any condition in which there is immobility of the shoulder joint due to trauma, overuse injuries, and/or surgery.  Increased risk factors also include systemic diseases such as hyperthyroidism, hypothyroidism, cardiovascular disease, and Parkinson’s disease. (WebMD) 

There are three main stages of frozen shoulder.  The first stage is the painful stage.  This first stage involves pain upon movement, muscle spasm, increased pain at night and at rest.  The second stage is the adhesive stage.  This stage actually exhibits decreased pain, but involves increased stiffness, and decreased range of motion.  This will hopefully lead into the recovery Stage.  This stage is usually characterized by a further decrease in pain, and range of motion should begin to improve. (American Family Physician)

Some common forms of treatments include NSAIDs with physical therapy, arthroscopic surgery, manipulation under anesthesia, and chiropractic manipulation with associated soft tissue treatment. (NYTCO)

The use of active vs. passive range of motion to determine extra-articular vs. capsular pathologies in one way to differentiate the diagnosis.  When performing range of motion of the shoulder, remember that the ratio of GH to scapula-thoracic motion should be 2:1, or 120:60 degrees.  True frozen shoulder disorders will demonstrate scapula-thoracic movement only, and NO GH movement.  A common cause of frozen shoulder may be subscapularis trigger points which affect the sympathetic vasomotor activity which eventually leads to hypoxia of the surrounding tissue including muscles, ligaments, and tendons, and also the proliferation of fibrous tissue. (Murnaghan)  The second rib should also be checked for motion, as it can commonly be affected by frozen shoulder. (Polkinghorn)

In conclusion shoulder diagnosis has been historically difficult due to the nature of this incredibly complex joint.  The prognosis is considered good, and usually sees full range of motion return in 12-24 months depending on severity and treatment. (Anton) Remember that over 20 muscles are connected to the shoulder girdle which may all be affected or contributory to this condition.  It is important to try to address this issue as soon as possible, and follow up with continuous treatment until full range of motion has been regained.  And continue to monitor this issue even after full range of motion has been restored, to prevent its return.  




American Family Physician. via The New York Times Company.

Murnaghan JP. Adhesive capsulitis of the shoulder: current concepts and treatment. Orthopedics. 1988 Jan;11(1):153-158. [PubMed]

H.A Anton Canadian Family Physician 1993 August, 39 1773-1778

Polkinghorn,B.S., 1995. Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. J Manipulative Physiol Ther, 18,(2), 105-115

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