From the Guidelines
Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by stiffness and pain in the shoulder joint, occurring when the capsule surrounding the shoulder joint thickens and tightens, restricting movement and causing discomfort. This condition is one of the several causes of poststroke shoulder pain, as noted in the study by 1. The development of frozen shoulder is associated with various factors, including motor weakness, spasticity, and abnormal joint mechanics, as discussed in the guidelines for adult stroke rehabilitation and recovery by 1.
Key Characteristics of Frozen Shoulder
- The condition typically develops gradually in three stages: freezing (increasing pain and stiffness), frozen (decreased pain but significant stiffness), and thawing (gradual improvement in mobility) 1.
- It is more common in people with diabetes, thyroid disorders, or after periods of immobilization, and typically affects people between 40-60 years of age, with women being more frequently affected than men.
- Treatment usually involves pain management with medications like NSAIDs (ibuprofen, naproxen) or acetaminophen, along with physical therapy exercises to maintain and improve range of motion.
Treatment and Management
- In severe cases, corticosteroid injections, hydrodilatation (stretching the joint capsule with fluid), or surgical intervention may be necessary, as suggested by 1.
- Proper positioning, maintenance of shoulder range of motion, and motor retraining are also beneficial interventions for patients with hemiplegic shoulder pain, including those with frozen shoulder, as noted in 1.
- The use of slings, especially during ambulation training to protect the shoulder from traction injury, may be considered, and the use of overhead pulley exercises should be avoided, according to 1.
Importance of Recent Evidence
The most recent guidelines for adult stroke rehabilitation and recovery by 1 provide valuable insights into the management of frozen shoulder, emphasizing the importance of a multifaceted approach to treatment and highlighting the need for further research into the efficacy of various interventions. By prioritizing the most recent and highest-quality evidence, healthcare professionals can provide optimal care for patients with frozen shoulder, minimizing morbidity, mortality, and improving quality of life.
From the Research
Definition and Overview of Adhesive Capsulitis (Frozen Shoulder)
- Adhesive capsulitis, also known as frozen shoulder, is a challenge to treat clinically 2.
- It is a common and painful musculoskeletal disorder characterized by inflammation of the joint, stiffness, and restricted motion and strength 3.
- The condition is marked by a fibrotic inflammatory process of unknown etiology, with main symptoms including pain, stiffness, and loss of joint mobility 4.
Pathophysiology and Stages
- Adhesive capsulitis is considered fibrosis of the glenohumeral joint capsule with a chronic inflammatory response 5.
- The condition progresses in three stages: freezing (painful), frozen (adhesive), and thawing, and is often self-limiting 6.
- The pathogenesis of adhesive capsulitis may be associated with low-grade chronic inflammation and infection, insulin resistance, and omics-science, as well as psycho-emotional stress factors and pathogenic immune challenges 4.
Treatment Options
- Common conservative treatments for adhesive capsulitis include suprascapular nerve block (SSNB), intra-articular corticosteroid (IACS) injection, hydrodilatation, and physical therapy 2.
- Combining SSNB with physical therapy and/or IACS injection, and combining IACS injection with physical therapy, have support in the literature for improving shoulder pain, range of motion, and function 2.
- Physical therapy exercises targeted at adhesive capsulitis can be used in combination with common analgesics to manage the condition 6.