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Category: <span>Pain</span>

By SMA2000 September 21, 2016 Pain, Physio

Understanding Adhesive Capsulitis

Often called a stiff or “frozen shoulder,” adhesive capsulitis occurs in about 2% to 5% of the general population. It affects women more than men and typically occurs in people who are over the age of 45. Of the people who have had adhesive capsulitis in one shoulder, 20% to 30% will get it in the other shoulder.

What is Frozen Shoulder (Adhesive Capsulitis)?

Adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause of adhesive capsulitis is a matter for debate. Some believe it is caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an “attack” against its own substances and tissues. Other possible causes include:

  • Reactions after an injury or surgery
  • Pain from other conditions—such as arthritis, a rotator cuff tear, bursitis, or tendinitis—that has caused you to stop moving your shoulder
  • Immobilization of your arm, such as in a sling, after surgery or fracture

Often, however, there is no known reason why adhesive capsulitis starts.

Frozen Shoulder-Small.jpgFrozen Shoulder: See More Detail
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How Does it Feel?

Most people with adhesive capsulitis have worsening pain and then a loss of range of movement. Adhesive capsulitis can be broken down into 4 stages, and your physical therapist can help determine what stage you are in:

Stage 1 – “Pre-Freezing”

During this stage, it may be difficult to identify your problem as adhesive capsulitis. You’ve had symptoms for 1 to 3 months, and they’re getting worse. There is pain with active movement and passive motion (movements that a physical therapist does for you). The shoulder usually aches when you’re not using it, but pain increases and becomes “sharp” with movement. You’ll have a mild reduction in motion during this period, and you’ll protect the shoulder by using it less. The movement loss is most noticeable in “external rotation” (this is when you rotate your arm away from your body), but you might start to lose motion when you raise your arm (called “flexion and abduction”)or reach behind your back (called “internal rotation”). You’ll have pain during the day and at night.

Stage 2 – “Freezing”

By this stage, you’ve had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but this is limited by both pain and stiffness.

Stage 3 – “Frozen”

Your symptoms have persisted for 9 to 14 months, and you have greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder as far you can move it.

Stage 4 – “Thawing”

You’ve had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate.

By SMA2000 September 21, 2016 Pain, Physio

Physical Therapy vs Opioids

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends nonopioid approaches including physical therapy.

Patients should choose physical therapy when …

  • … The risks of opioid use outweigh the rewards.
    Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
  • … Patients want to do more than mask the pain.
    Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
  • … Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
    The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
  • … Opioids are prescribed for pain. 
    Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with nonopioid therapies, such as physical therapy.
  • … Pain lasts 90 days.
    At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

“Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Related Resources:

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.