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Dr. D. Y. Patil Vidyapeeth, Pune
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Dr. D. Y. Patil College of Physiotherapy
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All You Need to Know About 'Frozen' Shoulder

All You Need to Know About 'Frozen' Shoulder

Learn about frozen shoulder causes, symptoms, treatments, & recovery. Discover effective physical therapy & surgical interventions for shoulder mobility.

DPU Physio
December, 30 2023
338

Frozen shoulder, also known as adhesive capsulitis, is a painful and limiting condition that affects the shoulder joint, causing stiffness, pain, and a decreased range of motion. Understanding the causes, symptoms, available treatments, rehabilitation choices, and preventive measures is crucial if you or someone you know is dealing with frozen shoulder. By arming yourself with this knowledge, you can effectively manage and overcome this condition, improving your quality of life.

Causes and Risk Factors

Frozen shoulder develops when the tissues in the shoulder joint capsule become thickened and stiff, restricting normal shoulder movement. We should analyze different aspects to find more effective ways to resolve this problem. Let's explore them:

Shoulder Immobility

Prolonged shoulder immobilization resulting from injuries, surgeries, or a stroke can trigger the onset of frozen shoulder. Lack of movement leads to the formation of adhesions and scar tissue within the joint capsule, limiting the smooth gliding motion of the shoulder joint and causing pain and stiffness.

Inflammatory Conditions

People with chronic inflammatory conditions like diabetes, thyroid disorders, and autoimmune diseases (such as rheumatoid arthritis) have an increased susceptibility to developing a frozen shoulder. Inflammation contributes to the thickening and tightening of the shoulder joint capsule, leading to decreased mobility.

Hormonal Imbalances

Fluctuations in hormones, especially in women, might influence the development of frozen shoulder. Women, particularly during hormonal shifts like menopause, have a higher likelihood of experiencing this condition. The connective tissues in the shoulder joint may experience reduced integrity and increased stiffness due to hormonal imbalances, which can limit mobility.

Stages of Frozen Shoulder

Frozen shoulder typically progresses through three distinct stages, each accompanied by specific symptoms and progression:

Freezing Stage

In this initial stage, individuals experience a gradual onset of shoulder pain and stiffness. Pain worsens with movement, particularly at night. Range of motion starts to decrease, making simple tasks like reaching overhead or behind the back challenging. The shoulder joint capsule becomes inflamed, leading to scar tissue and adhesion formation, which restricts mobility and causes pain.

Frozen Stage

During this stage, pain may decrease, but stiffness and limited range of motion persist. The shoulder joint feels "frozen," and movement becomes severely restricted. Everyday activities such as dressing, combing hair, or reaching for objects become difficult and may require assistance. Significant adhesions and scar tissue within the joint capsule contribute to the solid and immovable sensation in the joint.

Thawing Stage

The final stage involves a gradual return of shoulder mobility and a reduction in symptoms. Pain subsides, and the range of motion begins to improve. Full recovery from frozen shoulder may take several months to years, requiring patience and consistent rehabilitation efforts. Adhesions within the shoulder joint capsule start to break down, allowing for increased mobility and improved function.

Symptoms and Diagnosis

Recognizing the symptoms of frozen shoulder is crucial for early diagnosis and appropriate treatment. The common symptoms include persistent shoulder pain, especially during movement and at night. The pain is often deep and achy, occasionally accompanied by sharp, shooting sensations. Individuals also experience stiffness and limited range of motion in the shoulder joint, particularly when lifting the arm or reaching behind the back.

To diagnose frozen shoulder, healthcare professionals conduct a comprehensive physical examination, review the patient's medical history, and may order imaging tests such as X-rays or MRI scans. These tests help rule out other underlying conditions or injuries, confirming the frozen shoulder diagnosis.

During the physical examination, healthcare providers assess the range of motion of the shoulder joint, looking for limitations and signs of pain. They may also palpate the shoulder area to identify areas of tenderness or tightness. Imaging tests provide visual information about the joint structures, helping to exclude other possible causes of shoulder pain and limited mobility.

Treatment Options

When conservative treatments do not provide sufficient relief, non-surgical approaches become the next line of defense. These include physical therapy, pain management techniques, range of motion exercises, and heat/cold therapy. However, if non-surgical approaches prove ineffective, surgical interventions such as arthroscopic surgery, manipulation under anesthesia, or capsular release surgery may be considered.

Non-Surgical Approaches

When conservative treatments do not provide sufficient relief, non-surgical approaches become the next line of defense.

Physical Therapy and Exercises

Physical therapy is a primary treatment approach for frozen shoulder. Skilled physiotherapists design individualized exercise programs aimed at improving the range of motion, strengthening surrounding muscles, and alleviating pain. These activities consist of stretching, moving your body, and building strength. Physical therapy plays a vital role in frozen shoulder recovery, with therapists guiding patients through specific exercises that target the affected shoulder joint. These exercises help stretch the tightened capsule, improve joint mobility, and strengthen the shoulder muscles. Modalities such as ultrasound or electrical stimulation may also be used to aid in pain relief and tissue healing.

Pain Management Techniques

Managing pain and reducing inflammation can be achieved by taking prescribed medications like NSAIDs or analgesics. In certain situations, getting corticosteroid shots in the shoulder joint can temporarily ease pain and reduce swelling. Pain management is an important aspect of frozen shoulder treatment, as it improves comfort levels and facilitates participation in physical therapy. Corticosteroid injections are considered for individuals with severe pain that oral medications cannot adequately control.

Range of Motion Exercises

Regular, gentle, and controlled exercises prescribed by a physiotherapist can help restore mobility and flexibility to the shoulder joint. Gradually increasing the intensity and duration of these exercises over time improves shoulder function. Range of motion exercises are crucial for improving shoulder mobility and breaking down adhesions within the joint capsule. Physical therapists help patients by leading them through targeted exercises that gradually improve their ability to move, like swinging their arms, climbing walls, and receiving assistance during stretches.

Heat and Cold Therapy

Applying heat or cold packs to the affected shoulder can help reduce pain, alleviate inflammation, and improve blood circulation. Applying heat through a warm compress or enjoying a warm shower can help ease muscle tension, promote better blood circulation, and alleviate discomfort and stiffness. Cold therapy, through ice packs or cold compresses, helps reduce inflammation and swelling.

Surgical Interventions

If conservative treatments fail to provide sufficient relief, surgical options may be considered:

Arthroscopic Surgery

This minimally invasive procedure involves using a small camera and specialized instruments inserted through small incisions in the shoulder. Surgeons visualize and remove scar tissue, release the tight shoulder capsule, and improve joint mobility. With arthroscopic surgery, the chances of problems are lower, and you can heal faster.

Manipulation Under Anesthesia

In this procedure, patients are put under anesthesia, and the surgeon manipulates the shoulder joint to break up adhesions and improve range of motion. It is typically followed by a period of post-procedure rehabilitation. Manipulation under anesthesia is performed to forcibly move the shoulder joint, breaking down adhesions and scar tissue that restrict movement. This procedure is pain-free and followed by rehabilitation to maintain the gained range of motion and prevent adhesion recurrence.

Capsular Release Surgery

This surgical intervention involves making incisions to access the shoulder joint and surgically releasing the tightened capsule, allowing for increased shoulder mobility. Capsular release surgery is considered when other treatments have been unsuccessful. The surgeon carefully releases the tight capsule, improving shoulder mobility. This surgery is reserved for individuals with severe and persistent frozen shoulder.

Rehabilitation and Recovery

Rehabilitation plays a crucial role in recovering from frozen shoulder and regaining full functionality. The rehabilitation process may include:

Ongoing Physical Therapy Sessions

Working with a specialized physiotherapist is essential. They design a comprehensive exercise program to improve strength, flexibility, and range of motion in the shoulder joint. Physical therapy sessions monitor progress, provide manual therapy techniques, and adjust exercises as needed for optimal recovery.

Home Exercises and Self-Care

Patients receive specific exercises and self-care instructions to continue their recovery at home. Performing these exercises consistently and following recommended self-care measures are vital for long-term improvement. Home exercises maintain progress achieved during physical therapy sessions, including stretching, and strengthening exercises.

Patient Education

Educating patients about proper posture, body mechanics, and strategies for preventing future shoulder problems is crucial. Learning to maintain good posture, avoid overuse injuries, and incorporate shoulder exercises into daily routines promotes long-term shoulder health. Physiotherapists provide guidance on ergonomic adjustments, activity modifications, and self-care strategies.

Prevention and Lifestyle Tips

While it may not be possible to entirely prevent frozen shoulder, adopting certain measures can help reduce the risk or delay its onset:

Maintain Good Posture

Practicing good posture throughout the day promotes better shoulder alignment and reduces the risk of developing shoulder problems. Avoid slouching and maintain a neutral spine position while sitting and standing.

Avoid Prolonged Shoulder Immobilization

After an injury or surgery, following healthcare providers' recommendations regarding shoulder movement and rehabilitation is crucial. Engaging in gentle range of motion exercises early on helps prevent shoulder stiffness and the development of frozen shoulder.

Perform Regular Shoulder Exercises

Engaging in regular shoulder exercises that focus on maintaining and improving range of motion helps prevent frozen shoulder. Consult with a physiotherapist for specific exercises suitable for your individual needs, including shoulder rotations, arm circles, and stretching the shoulder in various directions.

Manage Underlying Health Conditions

If you have diabetes, thyroid disorders, or other conditions associated with an increased risk of frozen shoulder, work closely with your healthcare provider to manage them effectively. Consistently monitoring and managing these underlying health conditions minimizes the risk of developing frozen shoulder.

Conclusion

Frozen shoulder can be a challenging and frustrating condition, but with proper understanding, early diagnosis, and a comprehensive treatment plan, individuals can regain shoulder function and improve their quality of life. By recognizing the causes, identifying the symptoms, seeking timely medical care, and following the prescribed treatment and rehabilitation strategies, individuals can effectively overcome frozen shoulder. Forming a strong partnership with healthcare experts, including physiotherapists and surgeons, is crucial in devising a personalized approach that accommodates your unique needs and aspirations. Remember, with patience and perseverance, you can conquer frozen shoulder and reclaim your shoulder's full potential.

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