Frozen shoulder Physiotherapy Treatment-mississauga

Frozen Shoulder Physiotherapy Mississauga – Frozen shoulder also called as adhesive capsulitis or periarthritis is characterized by the development of dense adhesions, capsular thickening and capsular restrictions, especially in the capsule. The onset is insidious and usually occurs between the ages of 40 and 60 years. 

Clinical signs and symptoms       

Acute Phase: Pain and muscle guarding limit motion, usually external rotation and abduction. Pain is frequently experienced radiating down the elbow and may disturb sleep. Joint swelling is not detected owing to the depth of the Capsule, although tenderness can be found by palpating the shoulder anteriorly and posteriorly.

Subacute phase: Capsule tightness begins to develop. Limited motion is detected, consistent with capsular pattern (external rotation and abduction are most Limited and internal rotation and flexion are least Limited). Often, the patient feels pain as the end of the Limited range is reached. Joint play testing reveals Limited joint Mobility. If the patient can be treated as the acute condition begins to subside by gradually increasing shoulder motion and activity, the complication of the joint and soft tissue contractures can usually be minimized.

Chronic phase: Progressive restriction of the shoulder shows signs of extreme limited motion in a capsular pattern and decreased joint play. There is significant loss of function with an inability to reach overhead, outward, or behind the back. Aching is usually localized to the deltoid region.

Common Impairments and functional Limitations

• Night pain and Disturbed sleep during acute flare up. Pain on motion and often on rest during acute stage.
• Decreased range of motion usually limiting external rotation and abduction.
• Faulty postures compensations and improper posture with protraction and anteriorly tipped scapula, rounded shoulders and elevated and protected shoulder.
• General muscle weakness and poor endurance in the shoulder muscles with overuse of the scapular muscles leading to pain in the trapezius and the neck muscles.
• The common functional limitation of the frozen shoulder is the inability to reach over head behind the head, out to the side, and behind back; thus, having difficulty dressing (such as putting a jacket or coat, reaching hand into the back pocket of the pants, reaching out a car window, self grooming or even bringing eating utensils to the mouth.
• Difficulty lifting heavy objects, such as dishes or cupboard.
•  Inability to perform and sustain repetitive movements.

Management of frozen shoulder:

Frozen shoulder has always been considered important because of the impact on the quality-of-life and long period of pain and treatment. It can usually take up to six months to one year depending on the severity of the condition.

Control pain, swelling and muscle guarding.

The Passive and active range of motion to decrease pain and improve joint mobility followed by Gentle light mobilization of the shoulder joint. Joint pendulum exercises as they have the effects of gravity to distract the humerus and helps decrease the pain. Gentle traction and oscillating  movements helps to decrease the pain. Self mobilization techniques may be used for home care.

Posture correction is another very important thing. Your physiotherapist may teach you to prevent and the frozen shoulder. Scapular movements are very important in maintaining the proper function of the shoulder.  

Improving the muscle performance

The physiotherapist providesexercises to correct the muscle imbalance, stabilization, flexibility, strengthening exercises for the shoulder girdle and teaching the patient how to activate the weak muscle and progress to strengthening functional pattern of motion. Early scapular stability exercises and closed chain rotator cuff exercises can be instituted. As the patient’s symptoms improve, active-assisted and active ROM activities can be added, along with open chain and proprioceptive exercises. A closed chain stabilization exercise is performed alternating isometric resistance or rhythmic stabilization. Stretching exercises to restore the joint range and increase mobility of shoulder girdle and upper trunk.    

Shockwave therapy is also very effective and has shown proven results for treating frozen shoulder condition. Therefore, the use of noninvasive and safe techniques that can speed up the healing process of the disease is important. Ultrasound therapy and laser therapy have also some proven evidences off its effectiveness. Shockwave Physiotherapy is quite popular among all other treament methods.

Occasionally, if no progress is made, your doctor may choose to perform a manipulation under anaesthesia or Cortisone Injection is given which is often to decrease pain and increase tolerance to exercises and stretches.