Unlocking Frozen Shoulder

Frozen shoulder can mystify both clinicians and patients. But it need not be as perplexing as it seems. Let’s dive into what we know about this complicated, yet treatable condition.

Table of Contents

Understanding Frozen Shoulder

In fact, physical therapy offers many substantive treatment options for helping patients with frozen shoulder regain movement, strength and function.

Formally termed shoulder adhesive capsulitis, “frozen shoulder,” is characterized by a progressive, often gradual and painful loss of shoulder movement.

The loss of movement is observed with both passive movement, as the clinician attempts to move the shoulder, and with active movement, in which the patient attempts to move his/her shoulder.

Patients will report difficulty or inability to reach in front, to the side and behind the back. They will find it difficult if not impossible to wash their hair, put on a coat, to clasp a bra or pull up their pants.

Your physical therapist is trained to identify the distinctive pattern of movement loss that is a hallmark of adhesive capsulitis.

One tricky factor is that the loss of motion can have similarities to what we see with other shoulder injuries. Your physical therapist will perform the appropriate tests to determine a diagnosis.

Prevalence and Risk Factors

Shoulder adhesive capsulitis is seen in 2 to 5 percent of the general population. The average age of onset is 55 and its prevalence skews slightly more to women than men, at a ratio of 1.4:1.

Research has found increased risk of developing frozen shoulder among patients with systemic conditions such as diabetes mellitus, obesity, dyslipidemia, thyroid disease, and cardiac disease.

For diabetes, the risk above the general population can be as high as 4-fold. Why is this? In 2023, Jong-Ho Kim et al published a study in the Diabetes & Metabolism Journal that touched on much of the research into the possible etiology of shoulder adhesive capsulitis. The article was titled The Risk of Shoulder Adhesive Capsulitis in Individuals with Prediabetes and Type 2 Diabetes Mellitus: A Longitudinal Nationwide Population-Based Study.

The authors cited several studies that have demonstrated that the hyperglycemic state associated with diabetes can alter the collagen matrix in the joints, leading to the creation of fibrotic tissue and inflammation.

Changes to connective tissue have been found in both type 1 and type 2 diabetes.

In their 2023 study, Jong-Ho Kim et al looked specifically at the association between Type II diabetes and shoulder adhesive capsulitis in Korea. They started with a database of more than 3.4 million people over the age of 20 who received national care in 2009 and 2010. They grouped them and looked for cases of adhesive capsulitis.

Interestingly, they found that among people with type II diabetes, those with adhesive capsulitis were older, had increased waist circumference, BMI, fasting glucose, higher blood pressure, higher total cholesterol and low-density lipoprotein cholesterol and triglycerides. They also found a higher proportion of females, higher incident of hypertension, dyslipidemia, and chronic kidney disease.

They cited the research of Katherine Esposito et al, who in 2002 published a study titled Inflammatory Cytokine Concentrations Are Acutely Increased by Hyperglycemia in Humans. According to this study, published in the journal Circulation (106:2067-72), hyperglycemia on its own is a pro-inflammatory state.

Physical Therapy Approach

Clinically, we see patients present with fibrotic changes to the glenohumeral joint and restrictions in both the glenohumeral joint (the shoulder joint) and the scapulothoracic region (the shoulder blade). And your physical therapist will target both of these regions during rehabilitation.

The physical therapy model is uniquely designed to be particularly helpful for the treatment of frozen shoulder.

Physical therapists understand that, just as the process of freezing can occur over time, so does the process of healing. It is frequently seen clinically that the patient and clinician must go at “the pace of the tissue,” gradually unwinding the tissue disfunction, and slowly but surely improving range of motion and restoring strength. Your physical therapist will work closely with you to unravel the dysfunction, layer by layer, until you have returned to your baseline.

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