Frozen Shoulder: Your all questions answered.
What is this condition?
The term frozen shoulder is used for a stiff and painful shoulder. This condition usually develops over a period of time, causing shoulder capsule to thicken and tighten, leading to decreased mobility, pain and discomfort.
Why does it happen?
The exact cause of the frozen shoulder is not fully understood, but several factors contribute to its development.
If your shoulder is not actively moving for a certain reason, like post fracture, post any arm injury which requires immobilisation, this situation can lead to stiffness and decreased range of motion which may eventually progress to frozen shoulder. Interesting fact is that it develops more commonly in non dominant arm simply because it is less active than your dominant arm.
If your shoulder joint is inflamed due to some condition like rotator cuff injury, shoulder bursitis, it can lead to shoulder stiffness.
Diabetes and hypothyroidism: If you have some autoimmune condition such as diabetes or hypothyroidism, or cardiovascular disease, there is a high risk of developing a frozen shoulder. As per some research studies the chances are 10-38% high in people suffering from diabetes and increased level of HbA1C is the deciding factor.
If we talk about age, frozen shoulder is more common in the ages of 40-60 years old and it tends to affect women more than men.
What happens inside the shoulder joint which leads to frozen shoulder?
In frozen shoulder, the shoulder capsule, which is the connective tissue that surrounds the shoulder joint, becomes thickened and tight. This causes a decrease in the space available for the shoulder joint to move, leading to stiffness and pain. When there is any injury, the tissues in the shoulder joint can become inflamed. This inflammation can trigger a process where scar tissue forms in and around the shoulder capsule, causing it to become thickened and less flexible. Changes in the composition or amount of synovial fluid can contribute to the development of stiffness and limited range of motion. Weakness or tightness in certain muscles can lead to altered movement patterns and increased stress on the shoulder joint, contributing to the development of the condition. Reduced use of a body part leads to anatomical reorganisation in the brain so less used parts can be easily damaged.
What are the 3 stages of frozen shoulder?
Frozen shoulder typically progresses through three main stages. These stages are:
Freezing Stage (Painful Stage): This initial stage of frozen shoulder is marked by increasing pain and stiffness in the shoulder joint. Shoulder movement becomes limited, and performing everyday tasks that involve reaching or lifting can be challenging. The pain is often more severe at night and may interfere with sleep. This stage can last anywhere from 2 to 9 months.
Frozen Stage (Adhesive Stage): During the frozen stage, the pain may decrease, but the stiffness and limited range of motion in the shoulder become more pronounced. The shoulder capsule is thickened and inflamed, further restricting movement. Activities that require reaching behind the back or overhead are especially difficult. This stage can last from 4 to 12 months.
Thawing Stage (Recovery Stage): In the thawing stage, shoulder mobility gradually improves, and stiffness begins to decrease. Range of motion exercises, physical therapy, and other treatments can help regain flexibility and strength in the shoulder joint. This stage can last anywhere from 6 months to 2 years.
How does a typical frozen shoulder patient feel?
A typical frozen shoulder patient may present with the following characteristics and symptoms:
Pain and Stiffness: One of the hallmark symptoms of frozen shoulder is persistent pain and stiffness in the affected shoulder. The pain is often dull or aching and may worsen with movement or at night, affecting sleep quality. Stiffness in the shoulder joint limits range of motion, making it difficult to perform daily activities that involve reaching, lifting, or moving the arm.
Difficulty with Daily Activities: Due to pain and restricted shoulder movement, individuals with frozen shoulder may have difficulty performing tasks such as getting dressed, closing hooks behind back, combing hair, reaching for items on high shelves in kitchen cupboards.
Pain at Night: Patient finds it painful to sleep on the affected side of the shoulder. Night sleep is often disturbed due to pain.
History of Triggering Event: While frozen shoulder can develop without an obvious cause, some patients may have a history of a shoulder injury, surgery, or prolonged immobilisation that preceded the onset of symptoms.
What is the treatment for frozen shoulder?
The management of frozen shoulder typically involves a combination of conservative treatments to address pain, stiffness, and limited mobility in the shoulder joint. The goal of treatment is to reduce inflammation, improve range of motion, and alleviate symptoms. Here are some common management strategies for frozen shoulder:
Ice packs or heat therapy can be used to alleviate pain and discomfort. In extreme pain, painkillers can be advised by your orthopedic doctor.
Physiotherapy plays a significant role in the treatment of physiotherapy by focusing on improving range of motion at shoulder joint and working on its strength.
Manual therapy and mobilizations can be used to loosen tight tissue and increase joint space.
Heat therapy or cold therapy may be recommended to help relieve pain and stiffness in the shoulder joint.
Transcutaneous electrical nerve stimulation (TENS) or ultrasound therapy may be used to reduce pain and promote healing in the shoulder joint.
Which exercises should you do at home for frozen shoulder?
These 5 exercises that can help improve range of motion and reduce stiffness in the shoulder:
Pendulum exercise: Stand and lean forward, supporting yourself with the unaffected arm on a table. Let the affected arm hang down and gently sway it in small circles, first clockwise and then counterclockwise.
Wand exercises: Hold a stick or wand with both hands, palms facing down and hands shoulder-width apart. Slowly lift the stick above your head and then behind your back as far as is comfortable. Repeat this motion for several repetitions.
Crossover arm stretch: Bring the affected arm across your body at shoulder height with the elbow slightly bent. Use your unaffected arm to gently press the affected arm closer to your chest until you feel a stretch. Hold for 15-30 seconds and then release. Repeat on the other side.
Towel stretch: Hold a towel in one hand and drape it over your shoulder. Grab the other end of the towel with the opposite hand behind your back. Gently pull on the towel with the unaffected hand, causing a stretch in the affected arm. Hold for 15-30 seconds and then release. Switch arms and repeat.
Wall climb: Stand facing a wall and use your fingers to “climb” up the wall as high as you can, raising your arm overhead. Slowly lower your arm back down. Repeat this motion for several repetitions.
Remember to perform these exercises gently and gradually increase the range of motion as tolerated. It’s important to consult with a healthcare professional or physical therapist before.
What should you avoid doing?
Avoid sleeping on the affected side.
Avoid lifting heavy bags on the affected shoulder.
Avoid straining yourself by extreme range of motion activities like bowling, or badminton or throwing something overhead with force.
Avoid exercising without warming up the area.
In conclusion, regular and gentle exercises, along with proper guidance from healthcare professionals, can play a crucial role in managing and improving the symptoms of frozen shoulder. Stay consistent with your exercise routine and seek professional advice for a more tailored approach to your recovery.
