Frozen Shoulder
- We don’t expect a frozen shoulder under the age of 40-45 years old (except if there has been a fracture).
- The patient describes a typical history : There was a trauma or some overuse followed by some pain, which disappears at first and then, after 3-4 days, the pain returns and increases every day.
- During the first 3-4 months the pain and the limitation get worse ; the pain is constant, even at night. The pain gradually eases. At the end of this evolution, the normal range has returned, even without treatment.
Why Rehab?
A frozen shoulder has a spontaneous evolution which could take up to 2 years, but, unfortunately with some permanent loss of lateral rotation ROM. Therefore, it doesn”t make any sense to await the spontaneous evolution and treatment should be given regardless of the stage of frozen shoulder.
Treatment Approaches:
In a stage I the shoulder is slightly irritated. The treatment consists of intensive capsular stretch, about 15’ per session, 3x/week, active end range mobilization shoulder – shoulder girdle and home exercise.
If the patient didn’t experience any discomfort after the first treatment, increase the intensity of the capsular stretch ; if, however, he suffered pain too long after the treatment, next time decrease the intensity.
Capsular stretch has proven effective in the relief of pain and recovery of ROM in up to 90% of patients with capsular stiffness.
Frequently Made Errors !!
A patient is seen in a stage I phase, not too much pain, not too much limitation of movement : just medication is prescribed. A few weeks later he isin a stage II, more pain and more limitation, then mobilization is prescribed… Wrong : if the patient is in a stage I, mobilization should be prescribed as soon as possible in order not to loose time.
In a stage 2 shoulder, we may focus more on passive mobilization techniques and , if possible, we can already try to mobilize in end range direction.The patient already may do some home exercise in order to mobilize the shoulder.
In a stage 3 The shoulder is highly irritated. Exercise and active mobilization are contraindicated. Manual distraction technique (it is not the purpose to mobilize, it is merely a pain reducing technique), about 25’ per session, 5x/week, no exercise, no active mobilization .Effect of the distraction technique : This inhibits nociceptive reflexes which result from the long-standing stimulation of the nocisensors. These reflexes would be responsible for increased sympathetic activity giving rise to vasoconstriction of the vessels around the joint.