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Frozen Shoulder (Adhesive Capsulitis)

Frozen Shoulder or Adhesive Capsulitis is a painful, disabling condition. There are no clinical causes or findings on X Rays. It has 3 stages:

Frozen (painful) stage,  which can last 2-9 months. There is a gradual increase in severe pain which is worse at night.

Freezing (restricted) stage, which can last 4-12 months. There is a gradual reduction in the range of movement of the shoulder and stiffness whilst the pain starts to subside.

Thawing Stage which can last 5-26 months. The range of movement starts to increase but may be less than before.

It can be classified as primary or secondary

Primary idiopathic frozen shoulder is often associated with other diseases and conditions such as Diabetes Mellitis, Thyroid diseases and Parkinsons. Secondary frozen shoulder can occur after shoulder injury such as fracture during which the shoulder has been immobilised, but also after rotator cuff tendon tear, subacromial impingement, biceps tenosynovitis and calcific tendonitis. It may appear without any other associated symptoms or conditions.

It is estimated that it affects 2-5% of the population, mostly in their 40’s to 60’s, with women affected more than men.

Treatment in the first stage is education, non-steroidal anti-inflammatories (NSAIDS) steroid injections and physical therapy. The latter can include gentle stretching, for only a few seconds, within the pain-free range and the use of heat and ice packs. Research has shown that combining NSAIDS or steroid injections with manual therapy are more effective than medication on its own.

During the second stage it is important to keep stretching for longer period of time and to add static or isometric strengthening exercises as well as using ice and heat packs.

During the third stage stretching should continue and a progression from static to resistance based exercises. Exercises should be undertaken with care to avoid increasing the pain and inflammation.

It is important to avoid holding the arm immobile such as in a sling and to try to avoid a hunched foreward posture.

An osteopath can diagnose the problem and advise on appropriate treatment and exercises for the affected and related areas of the body.