Will physical therapy help frozen shoulder?

Introduction:

What is frozen shoulder?

A condition that causes stiffness and pain in the shoulder joint, is often used injudiciously for any painful condition of the shoulder joint. However, there are two known entities which must me differentiated and a proper diagnosis should be arrived at, since the treatment of each is different. These condition are: 

(a)  Painful Shoulder 

(b) Adhesive Capsulitis 

So frozen shoulder physical therapy is an important part of treatment, so in this article you would come to know about the shoulder treatment as a whole.

(a) painful Shoulder: Any condition, around the shoulder that causes pain and limitation of movements of shoulder may be included in this group. Various conditions include tendinitis of the rotator cuff, bicipital tenosynovitis, sprain and tears of the rotator cuff and synovitis. The patient has limitation of movement which is more due to pain rather than due to intra-articular or capsular contractures. X-ray may show areas of calcification around the shoulder indicating a calcific tendinitis. 

(b) Adhesive Capsulitis: Capsular adhesions form as a result of inflammation in the capsule and synovium .The adhesion are more marked in the axillary fold, and the cause of capsular contracture is unknown. However, relative immobility of shoulder due to coronary artery disease, mastectomy, cervical spondylosis may lead to capsular contraction and thereby stiff shoulder. It affects mostly at the age of 40 to 60 years.

Clinical sign & symptoms of frozen shoulder:

Acute joint problems- Pain and muscle guarding limit motion, usually external rotation and abduction. Pain is frequently experienced radiating below the elbow and may disturb sleep.

Sub-acute joint problems- Capsular tightness begins to develop with limited motion is detected. Usually external rotation and abduction are most limited and internal rotation with flexion are least limited.

Chronic joint problems- Progressive restriction of the gleno-humeral joint capsule magnifies the signs of limited motion in a capsular pattern and decreased joint play. There is significant loss of function with an ability to reach overhead, outward, or behind the back. Aching is usually localised to the deltoid region muscle.

Clinically frozen shoulder is divided into three stages, they are as follows

1.Freezing Stage- It is characterized by intense pain even at rest and limitation of motion by 2 to 3 weeks after onset. These acute symptoms may last 10 to 36 weeks.

2. Frozen Stage- Characterized by pain only with movement, significant adhesions, and limited gleno humeral motions with substitute motions in the scapula. Atrophy in the deltoid, rotator cuff, biceps, triceps brachii muscle occurs. This stage lasts 4 to 12 months.

3. Thawing Stage- It is characterized by no pain and inflammation but significant capsular restriction from adhesions. This stage lasts 2 to 24 months or may be longer. Spontaneous recovery occurs on the average of 2 years from onset of frozen shoulder.

Diagnostic tests:

 Some test were performed by a licensed qualified Physical therapist for the confirmation of shoulder pain diagnosis, these test are 

1. Active test of range of motion(ROM) with slight overpressure at the terminal point of each movement.

2. Active resisted test of ROM, at the initial range usually there is no pain; however considerable resistance may be painful.

3. passive test of ROM-with the patient in supine position it is important to confirm the capsular pattern of restriction of the joint and the diagnosis of adhesive capsulitis.

4. Other test which are performed by patient includes

⬤ Hand on neck  

⬤ Hand on opposite shoulder 

⬤ Hand behind the back 

Physical Therapy of Frozen Shoulder

Physical therapy should be the first line of treatment for frozen shoulder before medications and surgery, the basic aim of physical therapy program is 

➤ To reduce pain 

➤ To increase extensibility of thickened and contracted capsule of shoulder at the anterior inferior border and at the attachment of capsule to anatomical neck of humerus.

➤ To improve strength of shoulder girdle muscles

➤ T improve mobility and function

Now comes the electrotherapy part of treatment followed by manual techniques performed by physical therapist, some machines were used for pain reduction and relaxation such as 

➤LASER machine

➤Ultrasound machine 

➤Hot & cold pack 

➤TENS machine 

After that some manual techniques are performed by physical therapist, so the patient is placed in supine position with the affected shoulder in maximum possible abduction and neutral rotation with elbow in 90* of flexion. The physical therapist grasping the arm ( as shown in the video) below the shoulder joint carries out relaxed passive gliding movements of the head of humerus on glenoid.

Mobilization by passive accessory movements of acromioclvicular (AC), sternoclavicular (SC) and scapulothoracic joint articulations are extremely helpful.

After the whole Physical Therapy session some home exercises were also taught by therapist to the patient for maintaining the joint range of shoulder, all the home exercises are described in the below video.

                       

Important Note regarding Frozen Shoulder

Patient's with diabetes respond extremely slowly to the treatment and feel much more pain and discomfort as compared to non-diabetics.

Shoulder Physical Therapy Rehabilitation is also explained in the video below

Conclusion: 

Condition like frozen shoulder can be treated with physical therapy if you start the treatment as soon as possible without too much delay otherwise the recovery time may prolong and physical therapy has no side effect on your body.

So if you like this article about the knowledge regarding shoulder pain, you can give your valuable feedback in the comment section.