Frozen Shoulder Syndrome
Frozen shoulder is characterized by disabling stiffness, severe, lightning bolt-like pain with attempted arm movements. Inability to sleep on the affected side without findings on diagnostic imaging tests The diagnosis is Adhesive Capsulitis also known as Frozen Shoulder Syndrome [FSS]. This is frequently encountered by physical therapists who treat patients in orthopaedic settings. This exquisitely painful shoulder disorder impairs active and passive range of motion, strength and function to the degree that a patient may be completely unable to use the affected extremity. Sometimes, the disorder predictably comes after a period of immobilization, but even more frequently, it can sneak up on its victim like a thief in the night.
In the general population, the incidence of FSS is approximately 2%, of which 70% of affected individuals are females.[i] There are 2 main types of FSS: Primary (idiopathic) , in which the condition arises “out of the blue” with patients unable to remember a specific incident that may have caused the pain and stiffness; and secondary FSS, in which patients can describe a condition or event that precipitated their shoulder dysfunction, such as an upper extremity trauma, surgery or period of immobilization.[ii]
Treatment options for FSS range from benign neglect, in which the patient receives no intervention other than passage of time; NSAIDs, or oral/injected corticosteroids to address inflammation; physical therapy to mobilize, stretch, and strengthen the shoulder; closed manipulation under anesthesia; arthroscopic capsular release; and open surgical release.
With or without the addition of anti-inflammatory and pain-relieving medications, physical therapy is the cornerstone of treatment for FSS. Joint manipulation and gradual progressive mobilization techniques are key to this process.
Throughout the entire rehabilitation process, the patient must perform a daily home exercise program to maximize gains during therapy.[iii] In the home setting the use of modalities such as heat assists in the “thawing” out phase of Frozen Shoulder Syndrome. Heat is preferred by most patients to prepare themselves in performing self-mobilization of the shoulder joint and exercise program because of the comfort and relief afforded by heat.
It is beneficial for the patients to choose a source of heat application that conforms to the contour of the joint, such as the one provided by FIRheat Heat Therapy ™. Far Infrared Heat Therapy is a modality that encourages the patients to be self-sufficient and compliant in their therapy program in order to decrease pain, reduce stiffness, eventually improve their physical function.
FSS is an extremely painful, debilitating condition that causes global shoulder pain, joint capsule contracture, muscle guarding and soft tissue tenderness and functional weakness. Physical therapy is an essential component to recovery, hastening the return of quality of life and functional ability to the patient.
In this day and age of limited insurance coverage and cost of lost wages from being unable to work from the disability, patients are compelled to learn how to manage their injuries under the guidance and supervision of their physical therapists. The availability of heat therapy products, such as FIRheat Heat Therapy ™ on top of the education they receive from the medical professionals will augment this rehabilitation process.
[i] Miller RH,Diabach JA.Adhesive Capsulitis chapter 44 – shoulder and elbow injuries. In:Canale ST,Beaty JH Campbell’s Operative Orthopaedics, 11th ed Philadelphia, PA: Mosby Elsevier; 2008: 2625-2627.
[ii] Gartsman GM, Williams MD. Adhesive Capsulitis, chapter 17 – shoulder. In: DeLee J,Drez D,Miller MD. Delee & Drez’s Orthopaedic Sports Medicine. 3rd ed.Philadelphia, PA. Saunders Elsevier, 2009.
[iii] Hannafin JA,Chiala TA. Adhesive Capsulitis. A treatment approach. Clin Orthop Relat Res. 2000; (372):95-109.
