From the Guidelines
Frozen shoulder, also known as adhesive capsulitis, primarily restricts movement in all three planes of motion: flexion/extension (sagittal plane), abduction/adduction (frontal plane), and internal/external rotation (transverse plane). The most significant limitations typically occur with external rotation and abduction of the shoulder. This condition develops when the capsule surrounding the shoulder joint becomes inflamed, thickened, and contracted, leading to the formation of adhesions. The restriction progresses in a predictable pattern, with external rotation usually affected first, followed by abduction and finally flexion. The pathophysiology involves initial inflammation that progresses to fibrosis and capsular contracture, causing the characteristic stiffness and pain. Some key points to consider in the management of frozen shoulder include:
- The importance of gentle stretching and mobilization techniques to increase range of motion, particularly in external rotation and abduction 1
- The potential use of analgesics, such as acetaminophen or ibuprofen, for pain relief, although the evidence for this is not strong 1
- The consideration of corticosteroid injections or other interventions to reduce pain and inflammation, as supported by guidelines for adult stroke rehabilitation and recovery 1 The limitation in these planes of motion significantly impacts daily activities such as reaching overhead, behind the back, or to the side. Treatment typically involves physical therapy focusing on gradually restoring motion in all affected planes, possibly supplemented with anti-inflammatory medications, corticosteroid injections, or in severe cases, surgical intervention to release the contracted capsule. It is essential to prioritize the restoration of motion in all three planes to improve functional outcomes and reduce the risk of long-term disability. By focusing on the restoration of range of motion and addressing pain and inflammation, individuals with frozen shoulder can experience significant improvements in their quality of life and functional ability.
From the Research
Planes of Motion Lost in Frozen Shoulder
The planes of motion lost in frozen shoulder include:
- Abduction: limited range of motion in abduction, with studies showing an average of 84% of the unaffected shoulder's range of motion 2
- Forward flexion: reduced range of motion in forward flexion, with an average of 94% of the unaffected shoulder's range of motion 2
- Internal rotation: limited range of motion in internal rotation, with an average of 75% of the unaffected shoulder's range of motion 2
- External rotation: reduced range of motion in external rotation, with an average of 73% of the unaffected shoulder's range of motion 2
- Backward extension: limited range of motion in backward extension, with an average of 96% of the unaffected shoulder's range of motion 2
Factors Affecting Range of Motion
The range of motion in frozen shoulder is affected by:
- Pain: pain at night and during motion is significantly correlated with changes in range of motion 3
- Muscle contraction: muscle contraction can limit range of motion in frozen shoulder 3
- Disease duration: disease duration is significantly correlated with changes in range of motion, particularly in external rotation 3
Treatment Options
Treatment options for frozen shoulder include:
- Oral steroid therapy: can provide early symptom relief and improve range of motion 4
- Exercise: can improve range of motion and function, particularly in abduction and external rotation 5
- Arthrographic distension: can improve range of motion and reduce pain 6
- Physiotherapy: can improve range of motion and function, particularly when combined with other treatments 6