Frozen Shoulder - Rethinking what we know

4 Aug 2017 12:09 PM - Toby Coy

Frozen shoulder, or as it is more technically know adhesive capsulitis is a condition that has long been established to have a very specific natural history with eventual self resolution. Treatments are largely ineffective and the cause is unknown. Which leaves us able to provide little comfort to those who develop it. Recent research has started to challenge even what we thought we knew about this condition...

1) The specific pathology is unknown. The term ‘adhesive capsulitis’ sounds a lot more specific than the condition is. There might be adhesion, the capsule may instead be constricted via contracture, or the limitation may be functional (neurological inhibition) rather than structural.

2) Outside restricted passive abduction and lateral rotation, pain on the coracoid process is associated with about 95% of frozen shoulder cases, so it’s a good indicator.

3) The idea that the condition has a ‘natural history’ of three phases without intervention (Freezing->frozen->thawing) is false. Specifically, there’s no evidence that the shoulder will get better (thaw) by itself. Unfortunately, there also isn’t an alternative evidence based treatment.

4) Massage can’t break down any adhesion that happens to be there, but if a component of the limitation is due to neurological inhibition and sensitivity to movement, massage may be useful. Every patient will respond differently, but if we can temporarily improve pain and/or ROM, that can be used to help with exercise compliance.

5) Corticosteroids work temporarily for pain, but should never be used by themselves. Same story as massage: use it to make the movement based approach easier and to improve quality of life during rehab.

Frozen Shoulder - Rethinking what we know

4 Aug 2017 12:09 PM - Toby Coy

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