Frozen Shoulder

Frozen shoulder is a debilitating condition that can make simple tasks such as reaching for object on a shelf or fastening your bra difficult. Knowing what it is, and the best treatment can get you back to doing the things you enjoy sooner.

What is Frozen Shoulder?

Frozen shoulder, otherwise known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint as well as loss of range of motion. It can result in a debilitating loss of function in the arm and is a condition that tends to worsen over time if it’s not treated correctly.

Anatomy of the Shoulder

The shoulder is a ball and socket joint that can move in many different directions. This joint, called the glenohumeral joint, consists of the head of the humerus and the glenoid cavity of the scapula. This joint is surrounded by a capsule filled with synovial fluid which helps to protect the joint and allows the arm to move smoothly. It also comprises many ligaments, muscles and tendons which also improved the stability of the shoulder.

A “Frozen” shoulder occurs when the capsule surrounding the glenohumeral joint stiffens and contracts. This may cause scar tissue or adhesions to form between the joint capsule and the head of the humerus.

This contraction restricts movement in the joint and therefore can limit shoulder range of motion making simple activities such as reaching difficult.

Symptoms

Typically, there is a gradual onset of symptoms which worsen over time before resolving, usually within one to three years.

The usual signs of this condition are severe pain (especially at night) and loss of movement in the shoulder. The pain is usually dull and aching and worse during the early stages of the disease and when the arm is moved. The pain is usually over the shoulder joint however it can also occur in the upper arm.

Frozen Shoulder develops in three stages which usually lasts over a 2 to 3 year period:

STAGE 1: FREEZING

During the “freezing” stage, the pain slowly increases. As this pain increases, the shoulder range of motion is reduced. This stage typically lasts 6 weeks to 9 months.

STAGE 2: FROZEN

During this stage, the pain does not worsen, in fact  it often actually improves. The shoulder remains stiff and the range of motion is restricted making daily activities more difficult. This stage can last 4-6 months.

STAGE 3: THAWING

During the thawing phase, the movement gets easier and may eventually return to normal. The pain also usually resolves. This can take between 6 months and 2 years.

Cause

It is a condition that is poorly understood; however it is believed an inflammatory process is involved. It can also occur if your shoulder has been immobilised for a period of time such as after injury, surgery or illness.

Risk factors

• Age: This condition commonly affects people aged between 40 and 60 years old

• Gender: This condition tends to affect more females than males

• Recent trauma: Surgery or injury that leads to immobility may cause the shoulder capsule to stiffen

• Diabetes: It is thought up to 20% of people with diabetes develop frozen shoulder

• Other conditions that may increase the risk of developing frozen shoulder include:

  • Stroke

  • Hypothyroidism

  • Hyperthyroidism

  • Cardiovascular Disease

  • Parkinson's Disease

Diagnosis

Your health professional will conduct a physical exam to assess the range of motion in your shoulder as well as your area of pain.

An X-Ray is important to exclude arthritis of the shoulder or any other cause of pain.

Treatment

 As a general rule, the condition is SELF LIMITING. This means that the condition generally gets better by itself. Usually, the goal of treatment is to control pain and preserve shoulder range of motion. Physiotherapy is useful to help maintain and improve your shoulder range of motion as well as shoulder function.

Advice and Activity Modification

• Your physiotherapist will instruct you on how to modify certain activities to make them easier and more practical whilst you have reduced shoulder range of motion. For example, when getting dressed, place the affected arm into the affected side sleeve first.

• You may also be taught how to position your arm more comfortably to support the weight of the shoulder e.g. using pillows.

• Avoid sleeping on the affected side

• Limit rest/avoid prolonged rest. It is still important to move and use your arm as much as you can in your normal daily activities.

• Maintain good posture – avoid slouching or hunched positions.

• Simple analgesia e.g. paracetamol may be used to for pain relief. Anti-inflammatories e.g. ibuprofen may also be effective. It is recommended that you consult with your GP if you plan on taking any medication.

Physiotherapy Exercises:

The aim of exercises is to maintain movement and strength. Initially, exercises will be provided with the aim to stretch the joint capsule. Then, these exercises will be progressed to improve range of motion and to strengthen the shoulder.

Here are some simple exercises that your physiotherapist may first prescribe. It is important to follow up with your physiotherapy so that they can progress your exercises according to the stage of your condition.

1. Shoulder stretch - Bring your affected arm across your chest. Use your non-affected arm to pull the affected arm as close to your chest as is comfortable. Hold for 30 seconds and repeat three times.

2. Pendulum exercise - Stand and lean on a table with your unaffected arm. Bend forward and let your affected arm hang down. Swing your arm in a circular motion as if you are drawing circles on the ground. Perform 10 repetitions in a clockwise, then anticlockwise direction. Repeat three times.

3. Finger crawl on wall – Stand close to a wall. Slowly “walk” the fingers of your affected arm up the wall until you have raised your arm up as far as you can within a comfortable range. Slowly lower the arm. Repeat 10 times.

4. Towel stretch – hold onto a towel behind your back with both hands. Use your unaffected arm to pull the affected arm up your back to until you feel a stretch. Hold for 30 seconds. Repeat 3 times.

   • For an advanced version of this stretch, place the towel over your unaffected shoulder. Grasp each end of the towel with your hands. Pull the towel upward with your unaffected arm until you feel a stretch in the affected shoulder. Hold for 30 seconds. Repeat 3 times.

Other Treatments

The following procedures may be considered by your doctor if recovery is slow.

• Cortisone (Steroid) Injections – These injections are given into the shoulder joint to provide short term pain relief. These are usually performed by a Radiologist.

• Hydrodilatation (Hydrodistension) – An injection of fluid is made into the joint capsule. The aim is to “distend” and stretch the joint capsule to break down the contractures. Post injection stretches and exercises are critical after this procedure to ensure long term improvement.

• Manipulation under anaesthetic – This procedure requires a hospital admission as well as a general anaesthetic. The shoulder is manipulated and injected with cortisone with the aim of breaking down the capsular adhesions. Physiotherapy is recommended soon afterwards to maintain the acquired full range of motion.

• Arthroscopic capsular release – this is a minimally invasive surgery which involves cutting the tight capsular tissues and clearing the scar tissue in the shoulder joint to allow the shoulder to move more freely.

If you have any questions about Frozen Shoulder, please feel free to contact us:

Phone: 9553 8145
Website: www.eqphysio.com.au
Or if you're in the area, drop on by and have a chat with us to see if we can help in any way. We're located at 1/45 Montgomery St, Kogarah NSW 2217.