Adhesive capsulitis or Frozen Shoulder (FS) is one of the common shoulder conditions in which people are suffering throughout the world. This musculoskeletal condition characterized by pain and restricted shoulder range of motion.it is affected for people who are at 50-60 years old and 3-5% of the population are affected (Le et al 2016). Mintken et al (2016) suggests that women have higher prevalence of FS (68%). The dominant hand is more often affected (Mezian, Coffey and Chang 2021). FS can be divided as idiopathic or primary and secondary adhesive capsulitis. No specific cause for idiopathic apsulitis and secondary capsulitis can be caused by
- Trauma and surgery or
- Pathological causes such as rotator cuff tears, glenohumeral subluxation, bicipital tendinitis, arthritis and diabetes mellitus (Ma 2011).
According to Shin et al (2019) FS has three stages which are
- Painful or freezing stage : Freezing stage is due to acute synovitis of the glenohumeral joint :This stage is very painful and can lasts 3-9 months.
- Frozen or transitional stage : can lasts 4-12 months
- Thawing stage. with markedly limited range of motion and painful stage(less painful than the 1 st stage).
Thawing stage is the final stage. Pain is very less and limitation of shoulder range of motion is still present, but it can be improved within 8-12 months. Hagiwara et al (2018) describes the pathological changes of shoulder capsule which are cell to cell matrix adhesion, collagen metabolism, blood coagulation and immune response.
These biological changes cause to movement restrictions and tendinitis of the middle glenohumeral ligament and other structures. FS affects capsule, rotator interval and ligaments to develop inflammatory and fibrotic contracture. However the etiology is not fully understood.
The most recognized theory is synovial inflammation along with fibroblastic proliferation around the rotator interval. (Mezian, Coffey and Chang, 2021)
However, Mintken et al (2016) explains that muscle inactivity of the shoulder joint is the main cause of the FS. Further explaining that muscle weakness can occur during shoulder pathologies such as tendinitis, contusions and fracture, which can lead to restricted scapulothoracic movements. They have also emphasized that muscular inactivity can lead to muscle spasms due to disturbances in metabolic process in soft tissues. In the early stages FS is exhibiting signs of inflammatory condition along with inflammatory related pain and in later stages the signs of inflammation gradually reduce and limitation of ROM is more prominent sign (Mezian, Coffey and Chang 2021).
ultrasound, plain magnetic resonance imaging, and computed imaging techniques such as radiographs, magnetic resonance imaging, computed tomography is not effective to diagnose FS
How effective is Cervical Manual therapy for frozen shoulder
Manipulation of the Cervical, thoracic spine and adjacent ribs can have positive impact of shoulder pain. (Bergman et al 2004). Sobel et al (1996) have stated that more than 40% of patients who complained of shoulder pain were exhibiting impairments of the cervicothoracic spine and adjacent ribs. Norlander etal (1996) in their study have stated that reduced mobility in cervicothoracic spine leads to increase risk of shoulder pain. Researches such as Hauswirth et al (2017), McClatchie et al (2009) and Wassinger et al (2016) conducted for the effectiveness of shoulder pain by mobilization of the asymptomatic cervical spine, using Mulligans’ SMWAM and had positive outcomes. Chaudhery and Dabholkar (2017) suggests that Mulligans’ Spinal Mobilization with Arm Movement (SMWAM) technique is based on the spine movement during shoulder girdle movements which are induced by the muscles attached to the cervical vertebrae, scapula and upper thorax. This treatment can be easily performed, and it is safe and effective approach.
McClatchie et al (2009) suggests that pain and limitation can originate from cervical region and there is an interrelationship between shoulder movements and cervical movements. According to Mulligan All shoulder movements induces both thoracic and cervical spine motions. This indicates that along with shoulder manipulations techniques, cervical manipulation techniques are also helpful to increase the outcome of the frozen shoulder.
