Frozen shoulder (also called adhesive capsulitis) is a common disorder that causes pain, stiffness, and loss of normal range of motion in the shoulder. The resulting disability can be serious, and the condition tends to get worse with time if it's not treated. It affects mainly people ages 40 to 60 — women more often than men. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.
The cause of frozen shoulder remains unclear, however, it is thought that the lining of the joint (the capsule) becomes inflamed, which causes scar tissue to form. This leaves less room for the humerus or arm bone to move, hence restricting the movement of the joint.
Frozen shoulder is thought to have an incidence of 3%-5% in the general population and up to 20% in those with diabetes. Its peak incidence between the ages of 40 and 60 and is rare outside these age groups and in manual workers and is slightly more common in women.
Bilateral contemporaneous frozen shoulder occurs in 14% of patients whilst up to 20% of patients will develop some form of similar symptoms on the other shoulder. Diabetes is the most common associated disease with a frozen shoulder and a patient with diabetes has a lifetime risk of 10%-20% of developing this condition.
Patients with frozen shoulder have a higher risk of having some form of pre-diabetic condition with abnormal fasting glucose or impaired glucose tolerance test.
Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.
- Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
- Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
- Thawing stage. The range of motion in your shoulder begins to improve.
Phase 1 – Freezing
This phase is usually the most painful phase of treatment and movement becomes gradually more and more difficult. The aim of the following treatments and exercises is to help control pain and maintain movement in the shoulder joint.
Exercises should be done as long as they can be performed pain-free. Mobility exercises and assisted shoulder exercises can help maintain shoulder mobility.
Shoulder stretching exercises for the muscles at the front and back of the shoulder can be done also to attempt to maintain as much movement as possible. Strengthening exercises will be customized to every individual, and we recommend them to start the strengthening program immediately.
Phase 2 – Frozen
During the frozen phase of treatment is where there is the least movement in the shoulder, but on the plus side, pain tends to have reduced. This phase should be about trying to maintain strength and as much mobility as possible.
Mobility exercises should be continued. Stretching exercises for the chest muscles and muscles at the back of the shoulder should also be maintained. Strengthening exercises can progress and performed to maintain muscle strength. Isometric or static contractions are exercises needing no joint movement and can be done without worrying about movement in the shoulder.
In our clinic, we may apply some mobilizations on the shoulder to increase the range of movement at the shoulder joint. This is especially beneficial to patients who have very limited movement in the shoulder and need more assistance.
Phase 3 – Thawing
The final phase of treatment and rehab is where the movement starts to return to the shoulder. This phase is all about getting the shoulder back to normal as quickly as possible by regaining full movement and strength. Mobility exercises and stretches will progress, but they will be within the boundaries of pain to restore your full mobility in the shoulder joint. Strengthening exercises will progress from isometric or static contractions to exercises using a resistance band, then eventually free weights or weight machines.
The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder's normal range of motion. The anti-inflammatory medication such as aspirin, ibuprofen might be prescribed for the short term. An ice pack or bag of frozen vegetables applied to the shoulder for 10 to 15 minutes several times a day can also help with the pain.
You may be given a corticosteroid injection into the shoulder joint or soft tissues. A series of research have been supported Corticosteroid injections, and “it appears to be a useful and effective treatment option in adhesive capsulitis, as they can at least provide good short-term symptom relief, although their long-term efficacy has not been demonstrated" (Read more). But the cornerstone of treatment is physical therapy, concentrating first on exercises that stretch the joint capsule, and later, on strengthening exercises. A physical therapist can show you how far to push yourself and can teach you the appropriate exercises. Once you've learned your limitations, you can practice most of your exercises on your own at home.
Dublin Sports Injury Clinic is a physical therapy clinic based in Pearse Street, Dublin 2. We have a holistic approach to our assessment and treatment. The initial assessment helps us to explore the cause of your injury and help you to get pain free shortly. We design a customized training program for you and we monitor your progress closely. In our clinic, the treatment of frozen shoulder will be tailored to the stage of the disease for every individual. We strongly advise you to sick for medical advice from a qualified therapist before trying any of the exercises we highlighted.
In addition, our team of therapist will guide you in treating the affected shoulder, they also recommend to train your unaffected shoulder. This will help avoid muscle imbalance.
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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. You can contact us if you would like to book an appointment or get some advice from our therapist.