Understanding frozen shoulder
Have you ever felt constant pain and stiffness in your shoulder joint? If so, you may have frozen shoulder. This condition is sometimes called adhesive capsulitis (formerly known as frozen shoulder), and this brochure will explain frozen shoulder and your role in its treatment.
Symptoms of frozen shoulder
The first and foremost symptom is shoulder pain and you may feel as if your shoulder joint is injured. Other symptoms may include
Increased pain when moving the shoulder joint.
Painful images of the shoulder joint to sleep.
Stiffness in the shoulder joint that interferes with daily activities.
Some restriction in lifting or rotation of the upper arm.
How does a frozen shoulder develop?
Women are more likely to get frozen shoulder than men, and the condition is common in women over the age of 40. Secondary frozen shoulder is often associated with endocrine disorders such as diabetes and hyperthyroidism, and some patients who have had a traumatic injury to the shoulder may eventually develop frozen shoulder.
About the shoulder joint
The shoulder joint is a joint made up of several parts that allow you to lift, rotate and swing your upper arm, but if you have frozen shoulder, a contracture of a specific part of the shoulder joint occurs, causing pain and stiffness when you move your upper arm.
Diagnosis of frozen shoulder
Your doctor will ask about your symptoms and medical history. He will ask about the mobility of your shoulder joint and see if it causes pain when you move your upper arm, and then perform shoulder imaging to rule out other conditions that may be causing similar symptoms in the shoulder joint.
Treatment of frozen shoulder
Functional training is the first step in the treatment of frozen shoulder. You can go to a rehabilitation physiotherapist to learn how to do functional exercises, and if functional exercises do not work, you will need further treatment.
Shoulder distraction training
Shoulder distraction is the best treatment for frozen shoulder. Daily distraction exercises can relieve pain and improve shoulder mobility, but it usually takes a long time to see results and you must be patient. The first step is to warm up with a pendulum exercise, which is performed in a standing position with the affected limb hanging freely and the healthy limb holding the back of a chair, slowly rotating the affected limb, swinging from side to side.
Physical Therapy
Your physician will recommend physical therapy. This hands-on instruction will help you learn how to perform mobilization exercises at home, and your physical therapist will also help you improve mobility by gently stretching and moving the affected shoulder.
Tips for shoulder mobilization
Anti-inflammatory and analgesic medications can help relieve pain and thus help you perform shoulder mobilization exercises.
Mild moist heat packs can relax your shoulder joint, and a hot bath can be used prior to the mobilization exercise.
Ice packs can help limit pain and swelling, and cold packs can be applied for a few minutes after the mobilization session.
Other treatment options
Your doctor may recommend further treatment if mobilization is not helping you, but keep in mind that there is no substitute for shoulder mobilization and your doctor may recommend that you continue with shoulder mobilization after other treatments.
Hormone injections
Hormone injections can help reduce inflammation and are usually given directly into the joint cavity.
It will not cure frozen shoulder, but it can help reduce pain during shoulder distraction exercises.
Surgical treatment
If simple shoulder distraction exercises do not relieve the pain and stiffness, you will need surgical treatment, before which you will be put under anesthesia.
Manual release: Your surgeon will slowly lift your upper arm until the joint capsule and ligaments are released.
Capsulotomy release: If manual release does not completely release the capsule, your doctor will release the capsule and ligaments through a large skin incision.
Arthroscopic release procedure: The surgeon performs the release of the joint capsule through several very small incisions.
You will need to start shoulder distraction exercises as soon as possible after the manual release or capsulotomy.
Restoring shoulder mobility
These mobilization exercises will help you regain shoulder mobility and relieve pain. Perform three sets of each retraction three times a day, holding each retraction for 30-60 seconds.
Supination
1. Hold the affected hand as high as possible on a stable surface such as a bookcase or door frame.
2. Straighten your upper arm and bend your knee to lower your body, stopping when you feel the shoulder joint stretch.
Note: Keep your back straight, and to increase the stretch bend your knee as much as possible to lower your body or raise your upper arm before the stretch begins.
Internal Tuck
Place the affected hand on the healthy shoulder and lift the elbow away from the body as far as possible to shoulder level.
Note: Be sure to bring your elbow across your chest and not toward your jaw.
Note: The above mobilization activities may cause discomfort especially when you first start mobilization, it may take a few months to get the results you want but once your shoulder heals there will be no reoccurrence of adhesions, so stick to your mobilization exercises and consult your doctor if you have any questions.
Internal rotation
1. In a sitting position, place the palm of the affected hand on the back with the palm facing backwards.
2.Put the palm of the healthy side under the palm of the affected hand and push up until you feel the shoulder joint traction.
Note: Keep your back straight. If you are not able to place the affected hand in the center of the back, you can simply bring it as close to the center of the back as possible.
If your affected hand is not able to reach the center of the back, just bring it as close to the center of the back as possible.
External rotation
1. Stand by the door and hold the door frame with the palm of the affected hand, flexing the elbow joint.
2. Hold the affected elbow with the other hand to keep it close to the body.
3. Stand in the same place and rotate your body away from the door frame, stopping when you feel the shoulder traction.
Note: Rotate your body as much as possible to increase the tension, but do not twist your back.
Full Range of Motion
Most patients can regain full range of motion in the shoulder, but it takes time to recover and you need to be patient and consistent with the retraction. Keep reminding yourself that prolonged mobilization will relieve pain and improve joint function. If after a few months of training there are no significant results, your doctor will suggest other treatments and with some time and effort you will be able to engage in the activities you enjoy.