An all too common shoulder condition faced by physical therapists and massage therapists is adhesive capsulitis which is commonly referred to as frozen shoulder. It can be extremely painful and movement of the affected shoulder is normally extremely limited. It arises when part of the joint capsule attaches to itself and when the person moves the shoulder then the attached part can be very painful. This condition can be referred to as primary or secondary. In the primary form, there is no discernible cause for the condition. The second form is generally caused by injury or damage to the area. This may include arthritis, rotator cuff injuries or surgery, among other things. Frozen shoulder generally follows three phrases. The first stage is the freezing one. This lasts between two to six months. During this stage, there will be a gradual reduction in the ability to move with a corresponding increase in pain. The second stage is frozen. Around four to twelve months after the initial onset, motion will become even more restricted. In some cases, the level of pain may decrease during this period. The final stage is thawing. During this stage, the joint has begun recovery and motion will begin to return slowly. Pain will also begin to decrease. Depending on the severity of the frozen shoulder, thawing can last anywhere from a few months to several years. Treatment of adhesive capsulitis may involve massage, physical therapy, exercise and stretching, anti-inflammatory medications, moist heat or cortisone injections. In rare cases which do not respond to traditional treatment, surgery may be required. It is important that treatment be done under the supervision of a physician to prevent further injury to the shoulder. Massage treatment for frozen shoulder may involve a combination of techniques. Deep tissue massage uses pressure to the muscles around the shoulder to encourage the release of the adhesions that cause the pain. Shiatsu uses pressure on the acupressure points along the meridians to release any energy blockages. Trigger point therapy is sometimes very effective. This technique focuses on specific points within muscles. When pressure is applied to the proper points, it can help relieve muscle spasms. Remedial and even Swedish massage may also be helpful. Long strokes and gentle kneading of muscles are utilized to reduce tension and stress, which can exacerbate the shoulder condition. Physical therapy is used to help regain movement of the frozen shoulder. The therapist will first use pain reducing methods such as heat wraps, ointments and creams to ease pain. In some cases, therapy may include massage to help loosen the area and improve circulation of the area. The physical therapist may perform stretching exercises to encourage 'thawing' of the frozen shoulder. Other exercises may be used to strengthen the area as well. Both weight-wearing and non weight-bearing exercises are typically utilized. In most cases, patients are sent home with a program of home exercises and stretches to do in addition to the work done in physical therapy. These exercises should be done several times a day or as recommended by the therapist or physician. Failure to comply with a home exercise plan will reduce the rate of recovery. Anti-inflammatory medications are commonly prescribed. These may include acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs). These have a dual purpose. First, they ease inflammation which can be impeding movement. Second, they relieve the pain that comes with this condition. Moist heat can be used for both relief of pain and loosening of the shoulder joint. A warm, damp cloth is applied to the shoulder for short periods of time. A warm shower or a soak in the bath can also be beneficial. Cortisone injections are sometimes used. It is not fully understood how beneficial these injections are for frozen shoulder. However, they do reduce inflammation in the shoulder, which can lead to a reduction in pain levels as well. Cortisone injections are sometimes combined with physical therapy as they can help patients achieve more stretching. In rare cases, forced manipulation or surgery may be indicated. Because of the risk of further injury to the shoulder joint, these options are generally only exercised in severe cases in which more common treatments have shown no improvement. In forced manipulation, anesthesia is used. Usually, the patient is sedated, but in some cases the physician may opt to only anesthetize the shoulder. While under anesthesia, the arm is forced up in order to break the adhesions at the shoulder joint. This can cause the patient a great deal of pain once the anesthetic wears off. However, it can bring about a dramatic improvement in the joint's mobility. In surgery, the patient is sedated with anesthesia. An arthroscope is inserted into the shoulder joint after a minor incision is made. The light and camera inside the device allow the physician to determine where the adhesion causing the frozen shoulder is located. Then, small tools inside the device are used to cut through the adhesions. This procedure is referred to as arthroscopic capsular release. Once the frozen shoulder is released, physical therapy is necessary to prevent its reoccurrence. If the patient fails to do physical therapy following the procedure, there is a good chance the shoulder will refreeze. Depending on the severity of the frozen shoulder and the individual patient, it may be necessary to use multiple treatments to find relief. In most cases, frozen shoulder sufferers can regain most (if not all) range of motion of the shoulder through combination of physical therapy, stretching and massage. However, there may a slight decrease in shoulder mobility even after healing occurs. Normally this is fairly mild and may only be observed with a detailed examination although it may last for a number of years.
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