They Say Frozen Shoulder is Self-resolving, but . . .

Affecting an estimated 2% to 5% of the general population, adhesive capsulitis (also known as frozen shoulder) ranks as the leading cause of pain at the shoulder joint among the middle-age and older.1

Affecting an estimated 2% to 5% of the general population, adhesive capsulitis (also known as frozen shoulder) ranks as the leading cause of pain at the shoulder joint among the middle-age and older.1 In this condition, the capsule holding the shoulder joint together thickens and progressively contracts. This causes gradually worsening pain and limited range of motion. Frozen shoulder can become debilitating. A shoulder can freeze on it’s own, or frozen shoulder can be brought on by any of a number of conditions, especially diabetes.2  

Frozen Shoulder Can Cause Years of Pain and Limited Function

For the good news, journals commonly refer to frozen shoulder as self-resolving. For the bad news, this uses a liberal definition of self-resolving. A closer read of studies shows that this “spontaneous remission” most commonly occurs between 18 and 36 months.3 Without treatment, people could suffer from this condition for years. What’s more, longer persistence has been documented in 40% of patients, and permanent functional loss occurs in 7 - 15% of patients.4,5   

Faster Relief and Better Protection from Frozen Shoulder

The actual good news is that frozen shoulder responds to multiple conservative approaches. The latest systematic review of conservative therapies lists the approaches with the best evidence.6

Individual Therapies Strongly Recommended for Frozen Shoulder:

  • Physiotherapy techniques & modalities
  • Stretching plus corticosteroid injections
  • Extra corporeal shock wave therapy

 

Treatments Shown Effective by Moderate Evidence:

  • Conventional physiotherapy techniques
  • Strengthening exercises
  • Mobilisation
  • Therapeutic ultrasound
  • Proprioceptive neuromuscular facilitation
  • Continuous passive motion
  • Whole-body cryotherapy
  • Specialized acupuncture

 

Each of these treatments were studied alone; the authors are not recommending them as a group. Severe cases may merit surgery. At Advanced Physiotherapy, we can provide individualised programs of mobilisation, stretching, strengthening, home exercise plans, and patient education – all designed to accelerate recovery and create lasting relief.

 

References

  1. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 2011 Apr 1;20(3):502-14.
  2. St Angelo JM, Fabiano SE. Adhesive Capsulitis. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020. PMID: 30422550.
  3. Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar 1;103(1):40-7.
  4. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Medical Journal. 2016 Dec;57(12):646.
  5. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery. 2008 Mar 1;17(2):231-6.Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2021 Jan 

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