Frozen
Shoulder
(Adhesive Capsulitis)
Frozen shoulder is a condition in which portions of
the joint capsule stick together and form adhesions. Adhesive capsulitis,
as it is properly known, can be potentially disabling and cause dramatic
loss of mobility in a relatively short period of time, even as little as
two to three weeks.
Because frozen shoulder is exacerbated by inactivity, rehabilitation of
this condition is one of the few instances when exercises should be done
beyond the pain threshold-but only when supervised by a physical
therapist.
Symptoms:
- Reduce shoulder mobility.
- Extreme pain on movement, especially with throwing motions.
- An ache when the shoulder is not being used.
Cause:
- Nonuse of the shoulder due to discomfort from an injury such as
tendinitis or bursitis.
Athletes at risk:
- Those who sustain overuse shoulder conditions such as tendinitis or
bursitis.
- Frozen shoulder is especially common among diabetics, smokers, and
menopausal women.
Concerns:
- If frozen shoulder is allowed to persist, two years of intensive,
continual physical therapy may
be necessary to correct the condition.
What you can do:
In conjunction with RICE therapy (Rest, Ice, Compression & Elevation), immediately begin a shoulder range-of-motion program within
the pain threshold. Because a carefully directed rehabilitation program is
necessary to correct this condition, athletes with a suspected frozen
shoulder should seek medical attention from a qualified sports doctor as
soon as possible.
Medication:
- For relief of minor to moderate pain, take acetaminophen as
directed on label.
- For relief of pain and inflammation, take ibuprofen or
aspirin if tolerated.
What the doctor can do:
A complete medical history and thorough
physical examination may be necessary to confirm the diagnosis and rule out other possible
causes for the complaint.
- Non-surgical treatment options:
- The doctor may prescribe an
intensive exercise program to restore range of motion to shoulder.
The
program should begin immediately, and should consist of high-repetition,
low-weight exercises
to the point of pain and slightly beyond- as much
as can be tolerated. Pain should not persist after the session.
- Depending on the degree of shoulder pain, over-the-counter and
prescription anti-inflammatories
are liberally
prescribed.
- Range-of-motion exercises and medication are usually
sufficient to promote recovery. If, however,
the pain persists or
worsens, and range of motion does not improve, deep heat therapy and the
prescription drug prednisone should be used for a limited
time.
- Surgery:
If physical therapy and
medication have not cleared up the condition in four to six months, the
best choice may be surgery. To break the adhesions, the patient is
placed under anesthetic, and the shoulder is physically manipulated
through its maximum range of motion. The arthroscope is then inserted into
the joint to help remove the adhesions and cut any of the capsule if the
shoulder does not have full motion. This procedure must be followed by a
comprehensive exercise program to ensure that range of motion is
maintained.
Rehabilitation:
- Frozen shoulder is exacerbated by inactivity, and for this reason,
rehabilitation should begin immediately. In addition to prescribed
exercises, patients should not hold back from using their shoulders for
daily activities, even when pain is extreme.
- Rehabilitation of frozen shoulder is one of the few instances when
patients should be encouraged to exercise beyond the pain threshold.
This is necessary to break up the adhesions that have formed through
inactivity. However, pain should not persist after the session.
- Athletes with frozen shoulder can usually begin their rehabilitation
with level two exercises, and should try to progress as quickly as
possible in the program. For levels one, two, and three rehabilitation
guidelines, refer to sections on rehabilitation and conditioning at the
end of this chapter.
Recovery time
Usually, at least two to three months are necessary to loosen a
frozen shoulder. However, in more severe cases it can take as long as two
years for the shoulder to regain full range of motion. It is crucial that
daily exercises continue- backsliding may be swift and discouraging.
Reprinted with permission from The Sports Medicine
Bible (HarperCollins), by Dr. Lyle J. Micheli,
former President of the
American College of Sports Medicine |
