Frozen Shoulder

Frozen Shoulder treatment and information

Frozen shoulder or adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve. The duration is different among patients and may last from 1 to 3 years.

Frozen shoulder typically develops slowly, and it develops in three stages. Each stage can last for several months.

• Freezing stage. Any movement of your shoulder causes pain, as the pain worsens, your shoulder’s range of motion starts to become limited.
• Frozen stage. Pain may begin to reduce during this stage. However, the inability to move your shoulder remains, and using it becomes more difficult.
• Thawing stage. The range of motion in your shoulder begins to improve. Complete return to normal or close to normal strength and motion typically takes anywhere from 6 months to 2 years.

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

The causes of frozen shoulder are not well understood. There is no clear connection to arm dominance or occupation. Below are a few factors that may put you at more risk of developing frozen shoulder:

Age and sex: People 40 and older, particularly women, are more likely to suffer from frozen shoulder.
Immobility or reduced mobility: People who’ve had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Several factors promote the development of frozen shoulder including:

• Rotator cuff injury
• Shoulder fracture
• Stroke
• Post surgical recovery

Major diseases: People who have certain diseases appear more likely to develop frozen shoulder. Diseases that might increase risk of frozen shoulder include:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Tuberculosis
• Parkinson’s disease

During your consultation a precise case history taking of your symptoms and thorough physical examination will be taken to help diagnose and understand the cause of your shoulder pain.

During the case history the practitioner may ask you questions such as;

• When did the pain and symptoms start?
• Were you doing anything when the pain started?
• Do you have any underlying medical conditions?

During the physical assessment the practitioner may carry out a series of tests for frozen shoulder including a postural assessment. They will also observe the range or motion of your shoulder and carry out some orthopedic tests.

In some cases and depending on the severity of the symptoms, imaging such as X-rays, MRI’s or ultrasound scans might be needed to understand the exact cause of the shoulder pain.

Your best ally in the battle against frozen shoulder is timing, having a treatment early may reduce the duration of your symptoms.

Manual therapy: is one of the first conservative approaches that you may use for frozen shoulder. There are different manual therapies available so a combination of different practitioners (physiotherapists, osteopaths, massage therapists) may be the best option for your condition. Your manual practitioner will work together with you to improve the functionality and the mobility of your shoulder.

During the treatment your practitioner may gently move your shoulder to relieve your pain, work on the areas of your body to improve your posture and use techniques to relieve muscle tension.

Your practitioner will show you exercises that you can do at home to help increase the range of motion of the shoulder and decrease the pain. These may involve stretching, strengthening and improvement of your shoulder flexibility.

Medication: If you decide to visit your GP, depending on the severity of your pain they may prescribe you with some oral medications to help with relieving your symptoms. Over the counter painkillers and anti inflammatory medications are prescribed as they can help with the pain and inflammation experienced during frozen shoulder.

Movement modification: During the early stage, your GP or your manual practitioner (such as physiotherapy, osteopath, chiropractor, massage therapist) may advise you not to move your shoulder in any way that causes you pain. For this reason you may end up ceasing doing some physical activities that are increasing your pain such as sports or going to the gym.

However, absolute inactivity is not a great idea for your shoulder so you should find, at your pace, a balance between pain free and painful movements.

For any doubts you can contact your GP or your manual practitioner for any suggestions about daily changes in your life like using a pillow or a towel to support your arm when you’re in your bed.

Corticosteroid Injection: If your frozen shoulder condition is getting worse and you are not getting any results with manual therapy treatment then your GP may offer you a corticosteroid injection. This is a strong anti inflammatory drug that is injected into the shoulder. It is used to help ease the pain and can make manual therapy such as osteopathy and physiotherapy more comfortable for you.

Surgical Intervention: most people with frozen shoulder, notice an improvement of their symptoms with self-treatment and conservative treatments. Sometimes pain remains severe even after multiple approaches. In this case your GP may refer you to a consultant (an orthopaedic doctor who specializes in bones and joints). Usually the orthopaedic consultant will carry out further examination and prescribe you more tests to confirm the frozen shoulder diagnosis. Your consultant my suggest one of the following procedures:

• Shoulder manipulation: this procedure is done while you are under the effect of a general anaesthetic. Your surgeon will move your shoulder around to stretch the tightened capsule and improve the flexibility of any scar tissues. Typically it is combined with a steroid injection to ease any painful symptomatology.
• Arthroscopic capsular release: arthroscopy is a type of surgery widely used to look inside and treat a joint. Your surgeon will look inside your shoulder joint and use special instruments to cut through the connective tissue in your capsule joint to loosen it and make it able to move freely. This is done under the effect of a general anesthetic.
• Arthroscopic distension therapy: in this procedure your surgeon fills your shoulder joint with fluid to break up scar tissue and free up the joint. This completely blocks pain from your shoulder area and you will stay awake during the procedure, but the surgeon will inject some local anesthetic into your shoulder.

The exact cause for frozen shoulder is not known therefore it is difficult to ascertain whether there is much we can do to prevent frozen shoulder from happening. However, among all of the risk factors mentioned above, one of the most common causes of frozen shoulder remains the lack of mobility. This may result during recovery from a shoulder injury or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor or physical therapist about exercises you can do to maintain the motion of your shoulder joint at a certain level.

Pendulum stretch: Do this exercise first. Let your arm hang down like a pendulum, and then gently swing it back and forth or in circles. Perform 10 reps in each direction (clockwise and anticlockwise), once a day. As your pain reduces, increase the diameter of your swing, but never force it. When you’re ready for more, increase the stretch by holding a light weight in the swinging arm.

Finger wall walking: Pretend your fingers are your feet and walk your fingers up a wall. Hold for a few seconds. Then walk your fingers back down. Repeat 3 times. Move closer to the wall as you repeat.

Towel Stretch: In standing position, place the back of your hand on the side you want to stretch attached to your lower back. Throw one end of a towel over your shoulder. Grab it behind your back with your other hand. Pull down slowly on the towel with your front arm. Let your back arm slide up. You will feel a stretch in your shoulder. Hold the stretch for a few seconds. Do this 3-5 times a day. Build up to holding each stretch for 20 to 40 seconds.