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Frozen Shoulder, It’s Time for a Name Change

Posted by Michael Lucido, PT, DPT, OCS, COMT, FAAOMPT on Feb 8, 2020 11:13:10 AM

Famous people and some corporations change their name for many reasons. Some want a fresh start, while others change them for political or religious reasons. In 1964, professional boxer, Cassius Clay, changed his name to Muhammed Ali. Recently, Priceline changed its name to “Booking Holdings” as a way to move more into the hotel and home booking business. Well, it’s time for another name change. But this time, in clinical orthopedics.

I’m talking about a certain shoulder condition. It’s known as ‘capsulite retractile’ by the French, and “Steiffschulter” by the Germans. And the American medical system refers to it as “frozen shoulder” or “adhesive capsulitis.”

The author of an article published in the Journal of Shoulder & Elbow, 2009 states that a more accurate term for “adhesive capsulitis” is actually “contracture of the shoulder.” This author perused the literature and summarized current surgical findings in support of  this proposed name change. Based upon histological studies from tissues harvested during arthroscopic procedures, myofibroblasts, fibroblastic proliferation and white scar were ubiquitous in and around the shoulder capsule - ligament complex. In addition, angiogenesis and granulating synovitis were also found around both the rotator cuff interval and long head of biceps. This type of cellular activity leaves the shoulder susceptible to shortened and fibrotic tissue. This creates the potential for pain and loss of shoulder function, for up to seven years, in approximately 50% of all patients diagnosed with adhesive capsulitis(1).

Other shoulder pathologies can present as “frozen shoulder,” namely rotator cuff tears and brachial plexopathies. The clinical reasoning and pattern recognition of “contracture of the shoulder” begins with loss of external rotation of the glenohumeral joint to both passive and active movements. If the shoulder plain x-ray is not remarkable for osseous abnormalities then we are left to reason various other conditions:

There are four additional conditions of the shoulder that allow for this restriction:

  1. Osteoarthritis of the glenohumeral joint
  2. Glenohumeral joint dislocation
  3. Damage to the capsule & superior/middle glenohumeral ligaments (spams of subscapularis) secondary to trauma.
  4. “Adhesive capsulitis” (acute, subacute phase spasm of subscapularis and pectoralis major (2)

It may be time for a name change, but regardless of the name there have been no advances in the treatment of this condition. One study demonstrated that aggressive physical therapy has been shown to be prolong the disease (4). Arthroscopic debridement has been the only intervention that has showed promise in reducing pain and improving function in matched control trials of other interventions including manipulation under anesthesia and intra-articular injection of corticosteroids (6).

In the meantime perhaps “best practices” of manual physical therapy are a home program to keep the glenohumeral joint moving, while directing more skilled manual therapy to the areas that make up the “shoulder girdle.” In NAIOMT’s Upper Extremity course (C-626) we show you how to keep the shoulder girdle moving while allowing the natural course of this disease to perhaps resolve itself.

 

Michael Lucido, PT, DPT

 

Join us at any of the upcoming C-626 Upper Extremity courses:

 

References:

  1. Bunker, T. Shoulder & Elbow 2009 1, pp 4–9
  2. Bunker TD. Time for a new name for frozen shoulder. Br Med J 1985; 290:1233–4
  3. Hollmann, J., et. al. Musculoskeletal Science and Practice 37 (2018) 64–68
  4. Diercks RL, Stevens M. Gentle thawing of the frozen shoulder. Journal Shoulder Elbow Surg 2004; 13(5):499–502.
  5. Smith SP, Deveraj VS. Bunker TD. The association between frozen shoulder and Dupuytren’s disease. J Shoulder Elbow Surg 2001; 10:149–51.
  6. Ogilvie-Harris D, Biggs D, Fitsialos D, Mackay M. The resistant frozen shoulder. Clin Orthop Relat Res 1995; 319:238–48.

Topics: shoulder pain, shoulder techniques, upper extremity

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