What is Frozen shoulder? How to treat it?
Dr. Sneha Ganatra
November 17, 2020
A frozen shoulder is a common shoulder condition which is usually characterized by a stiff and painful shoulder and medically termed as Adhesive capsulitis. The range of motion of the shoulder is limited which impacts the daily activities and the pain in initial stages is very disturbing.
We need to understand the basics of shoulder anatomy to understand Adhesive capsulitis. A shoulder joint is formed when the head of the upper arm bone called the humerus, which is in the shape of a ball, attaches itself to the socket part of the shoulder blade bone called the scapula. A connective tissue surrounds this shoulder joint, called the shoulder capsule. When this capsule becomes stiff and thick, it impacts the movement of the joint. The synovial fluid which is responsible to keep the joint lubricated is also reduced which causes even more restriction in movement. This condition is called the frozen shoulder or the Adhesive capsulitis.
Signs and Symptoms:
Symptoms of this condition start mainly with pain which slowly leads to restriction of movement. Range of motion can be restricted in either one direction or multiple. The condition can be categorized into three stages:
- First stage: This is normally called the ‘freezing stage’, where pain is the main symptom. It can start with mild pain and can range up to excruciating pain which can lead to disturbed sleep at night. Restriction of movement also increases. This stage is about 6 weeks to 9 months of duration.
- Second Stage: This stage is called the ‘Frozen stage’. This stage mainly entails the symptom of stiffness and hence the term ‘frozen’. The pain may lessen but the restriction of movement increases. The joint will be stiff to perform loads of daily activities. This stage is about 2 to 9 months.
- Third stage: This stage is called ‘thawing stage’. The pain reduces and also the range of motions begin to improve.
- Risk Factors associated with Frozen shoulder:
- Frozen shoulder is more common in the age of 40 to 60 years
- Women are more prone to Frozen shoulder than men.
- Health conditions such as diabetes are one of the risk factors for frozen shoulder. People with diabetes have more difficulty in recovering from the frozen shoulder as well.
- Certain surgeries may lead to limiting the arm movements such as mastectomy that can lead to frozen shoulder.
- Certain diseases that lead to restriction of shoulder joint such as stroke, fracture of arms, rotator cuff injury etc.
Your practitioner needs a physical examination to diagnose frozen shoulder. Symptoms and medical history are asked followed by examining your shoulder and arms. The shoulder shall be moved in every direction to ascertain the range of motions.
Both range of motions i.e active and passive are tested. Passive range of motion is where the practitioner moves the shoulder in every direction to know the ranges. And active is where the patient moves the shoulder himself. Examination of active and passive ranges both are noted for diagnosis and prognosis.
X-rays may be prescribed to see arthritic changes or other abnormalities.
Treatment of frozen shoulder:
The treatment of frozen shoulder involves a combination of the following to get speedy recovery:
- Medications to reduce pain and inflammation. Doctors may prescribe NSAIDs (non-steroidal anti-inflammatory drugs), painkillers and according to the condition, the doctor may also suggest steroid injection.
- Physiotherapy to improve the ranges and prevent further restriction of movements. We will see this in detail in the later part of the article.
- Home exercises programme. Apart from the exercises done by the physiotherapist in the center, it is recommended to do certain exercises at home for a speedy recovery.
- Manipulation under anaesthesia. Here the practitioner stretches the joint capsule to reduce the tightness under anaesthesia for increasing the range of motion.
If conservative management doesn’t work, surgery is also one of the options.
Physiotherapy in frozen shoulder:
Your physiotherapist may recommend you few electro-modalities to reduce pain and inflammation depending on the stage of your condition. The electro-modalities can include:
- Short wave diathermy (S.W.D)
- Ultrasound therapy
- Interferential therapy (I.F.T)
- Transcutaneous Electrical Stimulation (TENs)
Apart from these electrotherapy modalities, the physiotherapist includes a complete exercise regime which consists of stretching and strengthening exercises. There is combination of active and passive exercises. To increase the joint range of motion, the physiotherapist may also include joint manipulation techniques.
Stretching exercises includes active stretching with the help of certain equipment such as shoulder wheel, shoulder ladder, pulley etc. which you can find in the physiotherapy center. Strengthening exercises can be done with resistant exercises with resistance provided by physiotherapist, dumbbells, sand-bags and thera-bands.
Apart from the exercises done in the physiotherapy center, it is advised to do exercises at home as taught by the physiotherapist. This will help in achieving a speedy recovery and prevent further restriction of movement. Once recovered, these exercises will help prevent rebound of the frozen shoulder. Although one should be regular with the exercises.
Do you wish to prevent the frozen shoulder? The good news is that the home exercises prescribed to treat the frozen shoulder can be done to prevent the same. It basically includes movement of the shoulder joint in all directions till the full range of motion. Ask your physiotherapist, and he/she shall show you the exercises which can be easily performed at home.