The complex structure of the shoulder girdle, both in terms of articular, ligament and muscle, guarantees its high mobility while maintaining good stabilization and movement control. Unfortunately, the unusual properties of this area of the body may turn out to be the cause of severe pain and functional problems. When damage occurs in one place, it affects the remaining structures of the complex, which in turn makes injuries, contusions and dysfunctions of the shoulder complex one of the most challenging challenges for physiotherapists / osteopaths.
This term is used in the case of people suffering from a significant limitation of the range of mobility in the shoulder complex and experiencing severe pain. This condition consists in the appearance of a strong pathological inflammation, which results in a strong contraction of the ligaments and the articular capsule of the shoulder joint. Characteristic for this state is the phasing of the pathology. It is divided into 4 phases.
The first phase – it consists in the appearance of inflammation, gradual loss of fitness (limited mobility) and the presence of pain in the area of the deltoid muscle insertion. The most restricted movements are Abduction, flexion and internal rotation.
The second phase is characterized by pain and increasing limited mobility.
The third phase is the full freeze phase where the range of motion in the rim is negligible. The pain in this phase begins to diminish, which is often seen by patients as a sign of their symptoms subsiding. The fourth phase is called defrost phase. The pain disappears completely here, but the mobility limitations remain significant.
The literature indicates that the duration of the symptoms is 2 – 3 years. As mentioned above, the final stage of the disease is marked by significant mobility restrictions. Therefore, it is worth mentioning here about physiotherapy.
There are different opinions about the expediency and effectiveness of physiotherapeutic measures with frozen shoulders. As the basis of the disease process is the fibrosis of the articular capsule, it seems to be advisable to maintain the proper state of mobility despite the pain. From the author’s experience, and based on scientific research, work on improving the mobility and proper mechanics of the joint significantly accelerates the return to the state before the disease.
A middle-aged patient who comes to a physiotherapy office with a painful episode of the shoulder lasting several or several weeks, combined with a significant limitation of mobility. Initially, the person experienced a slight discomfort in the shoulder which appeared in extreme movements. After some time, the pain started to appear in my daily activities.
This prompted the person to see an orthopedist who usually sends the patient to an ultrasound of the shoulder and then gives the patient an intraarticular steroid to reduce inflammation (which is not a bad decision of course). However, although the pain has decreased, the mobility limitations remain (sometimes patients report that the range has improved temporarily – Yes, because the pain has decreased during the exercise) and the pain returns over time. In the meantime, the mobility restrictions continue to worsen and the hand “freezes”.