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Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder becomes very stiff and painful. There is a loss of shoulder motion and significant pain with many types of daily activities. The shoulder joint is surrounded by a membrane or capsule that becomes painful and then shrinks which prevents movement of the shoulder.

Who’s at risk?

• The most common risk factor is diabetes mellitus, especially type I. Adhesive capsulitis affects

approximately 10% to 20% of all diabetics.

• Affects more women than men.
• Usual onset begins between ages 30 and 65.

Other predisposing factors include:

o A period of enforced immobility, resulting from trauma, overuse injuries or surgery

o Hyperthyroidism

o Cervical disk herniation
o Cardiovascular disease
o Clinical Depression
o Parkinson’s disease
o Breast or chest surgery

What does Frozen Shoulder feel like?

  • Dull or aching pain; sometimes sharp with movement.
  • Pain in the outer region of the shoulder that can radiate into the outer upper arm
  • Worse at night and in cold environments
  • Inability to sleep on the affected shoulder
  • Stiffness in the shoulder that worsens over time

Frozen shoulder usually comes on gradually over time. It is usually associated with pain, stiffness and limitation in shoulder movement. Your strength is not usually affected.

Common symptoms include:
  • Pain in the front of the shoulder that radiates down the arm.
  • Stiffness with loss of range of motion.
  • Catching and popping sensation.
  • Weakness and the inability to lift the arm overhead.
  • Muscle atrophy (dissipation).

Causes of frozen shoulder :

Most cases of adhesive capsulitis do not have a predisposing risk factor involved and are called idiopathic. The cause of this type of frozen shoulder is unknown, but probably involves an underlying inflammatory process. The capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around. 

Frozen shoulder can also develop after prolonged immobilization because of trauma or surgery to the joint. Usually only one shoulder is affected, although in about 1/3 of cases, motion may be limited in both arms.

If a risk factor or predisposing factor is present and treatable, the underlying stiffness and pain in the shoulder will resolve with physical therapy and treatment for the underlying condition.

Stages of (idiopathic) Frozen Shoulder

Frozen shoulder develops slowly, and in three stages:

• Stage One: “Freezing”- Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2-9 months.

• Stage Two: “Frozen”- Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4-12 months.

• Stage Three: “Thawing”- The condition begins to resolve. Most patients experience a gradual restoration of motion over the next 12-24 months.

Treatment

  • Non-operative /conservative treatment includes:
  • Medications to reduce the inflammation and relieve the pain
  • A program of physical therapy, often combined with home exercises and other therapies to actively stretch and help restore motion and function
  • Heating or icing the shoulder

Exercises for Frozen Shoulder

Wall Crawl

  • Face a wall about half a metre away from you
  • Using only your fingers (not your shoulder muscles) crawl your fingers up the wall until you feel the onset of pain
  • Hold the position for 15 seconds and repeat 3 times

Wall Crawl exercise for frozen shoulder
Wall crawl end position hold this for 15 seconds

Towel stretch

  • Hold the ends of a bath towel using your hands
  • The towel should be behind you – your hand on the sore side near your buttock and the other hand next to your ear
  • Using the non-painful side, pull the towel upwards away from the ear until you feel the onset of pain in the sore shoulder
  • Hold the position for 15 seconds and repeat 3 times

Internal rotation exercise for frozen shoulder
Towel stretch exercise for frozen shoulder

Posterior shoulder stretch

  • Bring your arm on the affected side across your chest
  • Use your other hand to pull the elbow closer to your body
  • Hold the position for 15 secondsand repeat 3 times

Posterior shoulder stretch for frozen shoulder

External rotation stretch

  • Must keep your elbow at your side close to  a wall or stand in the middle of your room door.
  • Move slightly forwards until you feel the onset of pain
  • Hold the position for 15 seconds and repeat 3 time

External rotation stretch for frozen shoulder