Frozen Shoulder - Understanding, Managing, and Addressing Ancillary Issues

Frozen shoulder, or adhesive capsulitis, presents a significant challenge due to its impact on shoulder mobility and associated pain. This condition, characterized by stiffness and discomfort in the shoulder joint, progresses through three stages: freezing, frozen, and thawing, each affecting the patient's daily activities and quality of life. Beyond the primary symptoms of frozen shoulder, it's imperative to address the ancillary issues that arise from the condition, such as altered scapulo-thoracic rhythm, neck stiffness, and arm stiffness, to ensure a holistic treatment approach.

Understanding Frozen Shoulder

Frozen shoulder develops when the capsule surrounding the shoulder joint thickens and tightens, restricting movement. Symptoms typically include a gradual increase in pain and a decrease in range of motion, with the pain often worsening at night. The exact causes remain unclear, but prolonged immobilization, certain diseases (such as diabetes or thyroid disorders), being over 40, and being female are recognized risk factors.

Treatment Modalities for Frozen Shoulder

Osteopathic treatment

Frustratingly, frozen shoulder can be resistive to therapy in general. However, in some cases a combination of muscle contracture and trigger points can mimic frozen shoulder. These types of ‘dysfunctions’ respond well to manipulation and/or dry needling therapy. Even if a diagnosis of ‘frozen shoulder’ has been made, osteopathic treatment can aid by focusing on exercises to enhance flexibility and range of motion, crucial for breaking through the stiffness characteristic of frozen shoulder. Furthermore, the importance of treating ancillary issues cannot be overstated, as they significantly contribute to the overall discomfort and dysfunction associated with frozen shoulder. Alterations in the scapulo-thoracic rhythm, along with stiffness in the neck and arm, often result from the body's attempt to protect the shoulder, leading to a vicious cycle of pain and immobility. Here, osteopathic treatment can play a pivotal role in addressing these secondary issues. Techniques such as soft tissue manipulation, joint mobilization, and myofascial release are effective in relieving pain, restoring movement patterns, improving overall function and offering pain relief and mobility improvements.

Self-Care and Management

Engaging in self-care practices like applying heat or cold, performing home exercises, and staying active are vital components of managing frozen shoulder and its ancillary issues. Such practices complement professional treatment plans, enhancing recovery outcomes.

Medications

NSAIDs and corticosteroid injections are commonly used to manage pain and inflammation, providing relief and facilitating more effective physical therapy.

Surgical Options

In severe cases, procedures like shoulder arthroscopy or manipulation under anesthesia are considered to break up adhesions and improve mobility.

Emerging Treatments

Innovative treatments, including hydrodilatation, are under investigation for their potential to offer new solutions to those suffering from this condition.

Conclusion

Frozen shoulder, with its primary and ancillary challenges, requires a comprehensive treatment approach that addresses all aspects of the condition. Through a combination of professional medical interventions and diligent self-care, individuals can achieve significant improvements in mobility, pain relief, and quality of life. It's essential for patients to work closely with healthcare professionals to develop a personalized treatment plan tailored to their specific needs.

References

• Mayo Clinic. (2020). Frozen Shoulder. [online] Available at: https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

• NHS (2020). Frozen Shoulder. [online] Available at: https://www.nhs.uk/conditions/frozen-shoulder/

• American Academy of Orthopaedic Surgeons. (2019). Frozen Shoulder. [online] Available at: https://orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder/

• Lin, J.J., Hsieh, S.C., Cheng, W.C., Chen, W.C., & Huang, V. (2010). Adaptive patterns of movement during arm elevation test in patients with shoulder impingement syndrome. Journal of Orthopaedic Research, 28(5), 653-657.

• Franke, H., Fryer, G., Ostelo, R., & Kamper, S. (2015). Musculoskeletal disorders: The effectiveness of physical and manual therapy techniques. Manual Therapy, 20(1), 1-25.