Shoulder Therapy

Physiotherapy can help minimize the pain and dysfunction associated with a Frozen Shoulder and should be one of the first lines of treatment. An appropriate physiotherapy approach provides:

• A thorough assessment, including a detailed history, of the painful region and adjacent areas.
• Education about the condition, where you are at in the process and what to expect.
• Initiation of early movement, including manual therapy techniques and home exercises appropriate to the stage your Frozen Shoulder is in. This may include range of motion, stretching, and strengthening.
• Pain management strategies, both in clinic and at home. These could include acupuncture, electrical modalities, manual therapy, exercise. This will definitely include advice regarding regular movement of the shoulder, limiting aggravating activities, but continuing to use that arm as normally as possible.

Medical management, such as the prescription of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), oral steroids or steroid joint injections can be combined with physiotherapy approaches. Surgery is generally not indicated.

The shoulder joint is normally one of the most mobile joints in the body. However, this movement can be lost if you develop a condition called Frozen Shoulder (Adhesive Capsulitis). This is a relatively common shoulder problem characterized by gradual, painful stiffening of the shoulder that occurs in 3-5% of the general population. It will affect more women than men (~ 70% of cases), usually in middle age. Unfortunately, 20-30% of people who have had one shoulder affected by a Frozen Shoulder will eventually develop similar symptoms in the other shoulder.

The design of your shoulder joint allows significant freedom of movement of your arm through a full circle out front of your body, overhead and behind your body. It is a complex ball and socket joint formed by the rounded head of the upper arm – humerus – fitting in the shallow socket in the shoulder blade – glenoid cavity of the scapula or shoulder blade. The head of the humerus is held in the glenoid cavity by extensions of cartilage – labrum – around the edge of the glenoid cavity making the socket deeper. This is all surrounded by a complex organization of the rotator cuff muscle tendons, stabilizing ligaments and a sac, called the joint capsule, that envelopes the whole joint. The joint capsule secretes and contains the joint lubricating fluid (synovial fluid) and is constructed with folds of tissue that expand and contract with movement of the shoulder.

In a Frozen Shoulder the joint capsule surrounding your shoulder joint becomes inflamed. This inflammation causes scarring or adhesions to develop. As a result, the joint capsule tightens and restricts shoulder movement. The joint capsule has many pain sensing nerves in it, so when it is adhered or “stuck” to itself, the stretching of the capsule that occurs with movement can be extremely painful. Because of the inflammation, your shoulder can even ache at rest, when you are not moving it. When Frozen Shoulder develops, moving your shoulder becomes gradually more painful and difficult. You begin to have pain and difficulty with many everyday activities such as dressing/undressing, grooming, fastening your seat belt, working above your shoulder or reaching for objects. Often shoulder pain at night will interfere with your sleep.