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August 2012

Physio For Frozen Shoulder

Dr Ankur Gaur
 
The term ‘periarthritis’ commonly refers to the inflammation of tissues surrounding a joint and ‘periarthritic shoulder’ refers to the inflammation of the structures around the shoulder joints. The condition is also termed as ‘adhesive capsulitis’ and is commonly known as Frozen Shoulder. This latter term, for that matter, has come to be used to describe any shoulder condition that is painful and limits movement.
What Causes A Frozen Shoulder?

Primary adhesive capsulitis usually has no known cause of onset. However, the condition can also be secondary to virtually any other shoulder condition, including sprain or tear of structures surrounding the shoulder (tendinitis of rotator cuff, bicipital tenosynovitis, etc)

The onset is usually between 40 and 60 years of age. It is gradual with no cause, although it can develop gradually after trauma. Relative immobility of the shoulder due to coronary artery disease, mastectomy or other chest operations may also cause a frozen shoulder.

A body in motion tends to stay in motion and a body at rest tends to stay at rest! This means that the limited use of the shoulders can lead to capsular contracture and result in stiff shoulders. Finally, a frozen shoulder is very commonly seen in diabetic patients.

Stiff Shoulder And Diabetes

One reason why a frozen shoulder is common in diabetics could be the typical bonding of glucose (sugar) molecules with collagen protein - the process of ‘Glycation’. Collagen is one of the building blocks for the ligaments and tendons that hold the bones together in a joint.

In diabetics, the Glycation process contributes to abnormal deposits of collagen in the cartilage and tendons of the shoulder. This build up causes the affected shoulder to stiffen up.

Phases Of Pain

Phase 1: The pain is experienced in and around the joint. It is worsened by movement. There is minimal loss of range of motion around the shoulder.
Phase 2: The pain increases, seriously restricting movement. There is loss of range of motion. The joint starts to stiffen up.
Phase 3: The pain will reduce steadily, but the stiffness will begin to increase. There is loss of range of motion.
It is a self-limiting condition, which gets resolved in about 12–18 months in majority of the cases. The area affected is generally the shoulder region and is often referred to as the anterolateral aspect of the upper arm.
Treatment
  • The use of physical agents and electrical modalities (for thermal effect) can help in getting relief from the pain and will help in achieving maximum range of motion.
  • Active, passive and assisted rangeof- motion exercises are essential in the early phase. Passive distraction of the shoulder joint can be an effective way to achieve complete range of motion. When pain is still a major symptom, care must be taken to work the arm in available range, while pain-relieving modalities remain the treatment of choice.
  • Initial shoulder mobilizing exercises can be performed by the patient in supine (lying straight on the back) position or by lying on the side. If the patient is able to elevate the arm past 90 degrees, either forward (flexion) or side (abduction), then the weight of the arm acts as a mobilizing force. The patient is instructed to use either short oscillatory movements at the end of the available range, or slow, steady and sustained pressure at the point of resistance.
  • The less painful it gets while moving the arm, the more vigorously the stretches can be applied to the affected joint.
  • Free-swinging exercises can be carried out by the patient in a forward flexed position supporting the body weight with the hand of the unaffected arm on a chair. The aim of this exercise is to use the momentum of the arm to provide the mobilizing force.
  • Progression to resistance exercises is made as range of motion increases, so that the patient’s own musculature can start to provide a greater mobilizing force and strengthen the joint. As the shoulder gets less painful but more stiff with movement, exercises can be made more aggressive.
  • Slow prolonged stretches for a minute or two, at end of the available range, is a preferred method of mobilization combined with longitudinal distraction of the shoulder joint.
  • Weights, repetitions and range of motion exercises can be increased if the person begins to demonstrate the ability to control the use of the affected joint.
  • A majority of the patients recover in 10–12 weeks of treatment.

Dr Ankur Gaur Physiotherapist (Cardio Pulmonary Diseases), Relief Physiotherapy and Pain Management Clinic, Ghaziabad..