Frozen Shoulder

 Frozen Shoulder or Adhesive Capsulitis is a condition that affects the Shoulder Joint. The Shoulder is made up three bones – Shoulder blade (scapula), the collarbone and the upper arm bone (humerus). The shoulder is a ball and socket joint where the round head of the humerus fits into the socket. Connective tissue known as the capsule surrounds the shoulder joint and synovial fluid lubricates the shoulder capsule and joint so that it moves freely. In Frozen Shoulder, shoulder capsules become thicker and tighter and over time scar tissues are developed. Also, in many cases there is not enough synovial fluid to lubricate the shoulder. This limits the motion of the shoulder and in extreme cases the shoulder gets locked – hence called Frozen Shoulder

Frozen Shoulder

Man with Frozen Shoulder (Adhesive Capsulitis)

Causes and risk factors of Frozen Shoulder

Exact causes of Frozen Shoulder are not known. However, there are certain risk factors that enhances the chances of getting Frozen Shoulder

Age: Frozen Shoulder generally affects people between the age of 40 and 50

Gender: It is more common in women than in men

Diabetes: 10 to 20% of people with diabetes develop frozen shoulder

Recent Trauma: Injury, illness or surgery also makes you more vulnerable to develop frozen shoulder

Other conditions that increases the risk are:

    • Hyper and Hypothyroidism
    • Cardiovascular disease
    • Parkinson’s disease
    • Stroke
    • Tuberculosis
    • Breast Cancer
    • Open Heart Surgery
    • Depression
      Frozen Shoulder can sometimes develop alongwith other Shoulder conditions like Calcific Shoulder Tendonitis and Rotator Cuff Tear.

Symptoms of a Stiff Shoulder

The most prominent symptom is shoulder pain and limited range of motion in the shoulder. In mild cases, there will be pain however other functions of the shoulder remain unaffected. In severe cases, the mobility of the shoulder is very limited thus affecting the everyday tasks like bathing, dressing, driving etc. There will be trouble sleeping on the affected side. There are three stages of frozen shoulder:

Stage 1 (Freezing Stage) – In this stage, pain will be predominant with limited motion of the shoulder. Pain worsens at night making it difficult to sleep. This stage normally lasts for 6 weeks to 9 months.

Stage 2 (Frozen Stage) – In this stage, the pain may be reduced however the shoulder joint becomes more stiff. Performing day to day activities like bathing, dressing, driving etc becomes difficult. This stage lasts for 4 to 6 months

Stage 3 ( Thawing Stage) – This is the final stage where the motion of the arm gradually improves. Pain and stiffness starts to reduce. This stage can last from 6 months to couple of years.

Diagnosis of Adhesive Capsulitis

Your Shoulder Specialist will perform one or more of the following tests to diagnose Frozen Shoulder and determine its stage:

    • Physical Examination
    • X-Rays
    • Ärthrogram
    • Magnetic Resonance Imaging (MRI)

Treatment of Frozen Shoulder Syndrome

In many cases, Frozen Shoulder improves over time with or without treatment. However, treatment can help manage the pain better, relieve other symptoms and speed up the healing process.

Non-Steroidal Anti Inflammatory Drugs(NSAIDs)
In mild cases, non-steroidal drugs are prescribed to reduce the pain and swelling.

Physical Therapy
A customized physio therapy program will be charted out depending on your condition. Regular physical therapy has helped most of the patients gain the arm motion and recover from Frozen Shoulder.

Steroid Injections
In severe cases, where non-steroid medications do not help relieve the pain and the patient is unable to perform physiotherapy – Steroid injections are given to reduce pain and inflammation.

Frozen Shoulder

Surgery and Procedures

Shoulder Arthroscopy

If all the non-surgical conservative treatment fails to relieve the pain and symptoms, your Shoulder Doctor will recommend Shoulder Arthroscopy in selected cases. This procedure is designed to increase the range of motion and improve shoulder movement.

Manipulation under anesthesia

In this procedure, doctor provides the patient with anesthesia and then force the shoulder to move in several directions. This cuts and tears the scar tissues thus enabling increased motion of the shoulder.

Recovery and Rehabilitation after a Shoulder Therapy/Surgery

A physical therapy is necessary after surgery. Commitment to regular physical therapy has helped most of the patients recover completely from Frozen Shoulder and its symptoms.

What You don’t Know about Frozen Shoulder

When you have a frozen shoulder, the things that you normally do without a second thought tend to get cumbersome.  It can impair even the simplest of activities in your daily life, for e.g. fastening your bra or taking an object off an overhead shelf.

What is the reason for frozen shoulder?

Primarily, overuse of the shoulder triggers this condition.  It could be in the form of an injury or inflammation of the soft tissues surrounding the shoulder.

Am I at risk of developing frozen shoulder?

If you don’t get proper physiotherapy after tendinitis or an injury, there are chances of you getting a frozen shoulder.  The reason is when your shoulder is in a sling for a prolonged period of time, you are supposed to get intermittent stretching to enhance blood supply to the muscles and ligaments, the absence of which may trigger this condition.

Importance of physical therapy post frozen shoulder treatment?

If you are suspicious of suffering from a frozen shoulder or in the initial stages of developing one, consult a shoulder specialist without further delay.  The doctor may ask you to perform various movements with your arm to see if you can do proper range of motion with the shoulder in question.  You may be asked to reach across your chest to touch the opposite shoulder or down your back to touch the shoulder blade on the opposite side.  The doctor may go in for x-rays to make sure there are no problems that are hidden, arthritic changes or dislocation, for instance.  An MRI may also be ordered to rule out a rotator cuff tear.

If you are diagnosed of having a frozen shoulder, the first-line treatment is to restore range of motion and relieve pain.  Post conservative treatment, you can seek the help of physiotherapist to know how far you can push yourself.  Doing physical exercise during the time of rehabilitation is very important to keep the condition at bay.

Things to remember during the recuperative phase:

As you progress yourself during the rehabilitation period, it is important to avoid any activities that involve overhead reaching, lifting or anything that may increase your shoulder discomfort.  It has been found out that people who diligently follow the rehabilitation protocol are able to resume normal daily acidities within a short span of time.  Believe it or not, more than 90% of the people with frozen shoulder improve leaps and bounds by following nonsurgical route diligently.  However, complete recovery from a frozen shoulder may take time, anywhere between several months and years.  If there is disruption in your recovery and the shoulder discomfort is waxing and waning, go back to your doctor to chalk out the next step.  Rarely, frozen shoulder that is recalcitrant to traditional methods of treatments requires operative intervention.

Exercises to improve mobility:

You can do some exercises to improve the range of motion of the frozen shoulder.  It will also lessen your pain and stiffness of the affected joint.  Frozen shoulder exercises are said to be the cornerstone of treating frozen shoulder.  However, make sure you always warm up before performing these exercises.  It is advisable to take a warm shower or bath for 10 to 15 minutes.  You can also use a moist heating pad or a damp towel heated in microwave as an alternative to bathing.  While performing the following exercises, you can stretch the shoulder completely, but make sure that you are not overdoing and not to the point to being painful.

Pendulum stretch –  Allow the affected arm to hang down and rotate the arm in a small circle

Towel stretch – Take a three-foot towel and hold it behind your back, grab the opposite end with your had.  Use your good arm to pull it upward to stretch it

Finger walk – You can slowly raise your affected arm by walking your fingers up the wall (spider-like).

Cross-body reach – Hold the affected arm with your good arm and then slowly bring it up across the body

Armpit stretch – Using your good arm, lift the affected arm onto a shelf about breast-high. Gently bend your knees, opening up the armpit.

Outward rotation – Hold a rubber/elastic exercise band between your hands with your elbows at a 90°.  Make outward rotations with lower part of the affected arm two or three inches while holding the band.  Repeat 10 to 15 times once a day.

Inward rotation – Stand next to a closed door and attach one end of the rubber/elastic exercise band to the doorknob while holding the other end with the affected arm.  Make inward rotations and hold the elbow at a 90° angle.  Repeat 10 to 15 times once a day.

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Q&As on Frozen Shoulder

1) What Is a Frozen Shoulder?

Your shoulder is made up of three bones that form a ball-and-socket joint. They are your upper arm (humerus), shoulder blade (scapula), and the collarbone (clavicle). There’s also tissue surrounding your shoulder joint that holds everything together. This is called the shoulder capsule. In some cases, this capsule becomes thick and tight that mobility is curbed. This condition is called a Frozen shoulder. It usually involves pain and stiffness that develops gradually, gets worse and then finally goes away. This can take anywhere from a year to 3 years.

2) What are the symptoms of Frozen Shoulder?

The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move it. If you have a frozen shoulder, you are likely to feel a dull or achy pain in one shoulder. You might also feel the pain in the shoulder muscles that wrap around the top of your arm. You might feel the same sensation in your upper arm. Your pain could get worse at night, which can make it hard to sleep.

In typical cases, you go through three phases with a frozen shoulder. Each has its unique symptoms and timeline.

  • Freezing stage: Pain that gets worse over time and can last 6-9 months. You suffer from limited shoulder mobility
  • Frozen stage: Moving your shoulder becomes more difficult and it becomes harder to get through daily activities.
  • Thawing stage. Your range of motion starts to go back to normal. Can take 6 months to 2 years. 

3) How is frozen shoulder diagnosed?

To diagnose a frozen shoulder, your doctor will give you a physical exam. This physical exam will tell the doctor how bad the situation is. During the “active” part of the exam, they’ll let you move your shoulder on your own. During the “passive” portion, they’ll move it for you, and note the differences. A physical exam is usually enough to diagnose a frozen shoulder, but your doctor may also order imaging tests such as X-rays, ultrasound, or MRI to rule out other problems like arthritis or a torn rotator cuff that can also cause pain and limit how far your shoulder moves.

4) What is the Importance of physical therapy post frozen shoulder treatment?

If you suspect a frozen shoulder, get in touch with your specialist as soon as possible.  The doctor may ask you to perform various movements with your arm to see if you can do a proper range of motion with the shoulder in question.  The doctor may go in for x-rays to make sure there are no hidden problems, arthritic changes or dislocation, for instance.  An MRI may also be ordered to rule out a rotator cuff tear. The first-line treatment is to restore range of motion and relieve pain.  Post conservative treatment, you can seek the help of a physiotherapist to know how far you can push yourself.  Doing physical exercise during the time of rehabilitation is very important to keep the condition at bay.

5) Am I at risk of developing a frozen shoulder?

Certain factors may increase your risk of developing a frozen shoulder. People 40 and older, particularly women, are more likely to have frozen shoulders. People who’ve had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. People who have certain diseases like diabetes, thyroid diseases, cardiovascular disease, tuberculosis and Parkinson’s disease are at a higher risk of developing a frozen shoulder. 

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