Adhesive capsulitis, otherwise known as frozen shoulder, is a painful condition that results in limitations in range of motion in the shoulder joint that causes difficulty with daily activities and frequently, sleep. It is categorized into two types: primary and secondary. Primary or idiopathic adhesive capsulitis is a gradual onset of pain and stiffness at the shoulder joint without trauma or specific reason. Secondary is caused by several intrinsic or extrinsic factors ranging from diabetes, thyroid dysfunction, hypoadrenalism, rotator cuff pathologies, bicep tendinitis, arthritis, calcific tendinitis and many other pathologies. This condition can last anywhere from a few months to a few years. It is broken down into 4 stages: inflammatory, freezing, frozen and thawing stages.
What’s the best course of treatment?
A systematic review published in 2021 compared the efficacy of physical therapy interventions in the treatment of adhesive capsulitis. One study they looked at reported significantly better outcomes with using bee venom acupuncture combined with PT compared to NSAIDs and PT at the 12 week follow up. Another study focused on the Mulligan technique (type of mobilization), hot packs and TENS treatment compared to stretching and found superior effects. Static progressive stretching was found to have better benefits vs. conventional PT techniques alone. In patients with diabetic frozen shoulder, adding lower trapezius strengthening proved to be an effective tool in clinical outcomes. Modalities such as extra corporeal shock wave therapy also proved to be a significant tool vs cortisone injection.
What should I do?
There are currently many limitations in most of these studies, however, it has been proven that physical therapy combined with some modality, injection or other technique seem to provide the patient with the best possible outcome. Larger studies need to be performed in order to strengthen the evidence; however, most treatments improve functional outcomes and decrease pain, which is ultimately improving the quality of life for each patient. In the end, go with what your healthcare provider deems necessary for you at the time, but consider all possible treatment avenues that were discussed in this blog post if you seem to be stuck in your rehab. If you are in the Mission Viejo area and think you, or someone you know, might benefit from physical therapy, please don’t hesitate to reach out!
1. Nakandala, Piumi et al. ‘The Efficacy of Physiotherapy Interventions in the Treatment of Adhesive Capsulitis: A Systematic Review’. 1 Jan. 2021 : 195 – 205.