Frozen Shoulder

What is Frozen Shoulder?

Frozen shoulders refer to pain and stiffness in either shoulder that makes it difficult to move. It limits the shoulder’s range of motion that starts slowly, and gradually gets worse over time. The condition generally improves over the period but on average can last between one and three years. The Frozen Shoulder physiotherapy treatment can vary depending on the individual case, and the physiotherapist will create a treatment plan based on individual’s specific needs and goals.

There are several factors and conditions that can restrict the movement of the shoulder joint and lead to frozen shoulder i.e. A shoulder fracture restricts movement and can cause stiffness in the joint. Paralysis or pain around the shoulder joint can also cause stiffness in the joint.

In frozen shoulder, the shoulder joint capsule gets thick and tight, making it hard to move thus limiting the shoulder movement. This causes the formation of the scar tissue and reduction in the synovial fluid to keep the joint moving smoothly that makes it even harder for the shoulder to move. Other commonly used terms for frozen shoulder are adhesive capsulitis, painful stiff shoulder, periarthritis or an idiopathic restriction of shoulder movement.

Signs & Symptoms

The signs and symptoms of frozen shoulder typically develop gradually over time and may include

  • Shoulder pain and stiffness that gets worse over time.
  • Pain at night that disturbs the sleep pattern.
  • Shoulder pain even at rest that gets worse with movement.
  • Muscle spasms in neck, shoulder joint, or near collarbone.
  • Trouble reaching over head or behind.
  • Muscle weakness

There are often three stages of symptoms for frozen shoulder:

  • Freezing stage- During this stage, there is a lot of inflammation in and around the joint, which causes a lot of pain and makes it hard to move around. Shoulder movement is limited both when the shoulder is moving and when it is resting. Shoulder movement is limited in certain directions. This phase could last between 2 and 4 months.
  • The Frozen Stage: This stage of frozen shoulder can last from 4 to 12 months. In the beginning of this stage, it can be painful, but as it goes on, it gets much harder to move around. Pathologically, this is when there is less inflammation and a lot of scarring (fibrosis) of the capsule and ligaments.
  • The Thawing Stage: In stage three, there is less pain and movement slowly comes back as swelling and scarring go away. This phase can go on for as long as 26 months.

Risk Factors & Causes of Frozen Shoulder

The exact cause of frozen shoulder is not known, but there are certain risk factors that can increase the likelihood of developing the condition. Here are some of the common risk factors:

  1. Age: Frozen shoulder is more common in people over the age of 40.

  2. Gender: Women are more likely to develop frozen shoulder than men.

  3. Medical Conditions: Certain medical conditions such as diabetes, thyroid disorders, and heart disease can increase the risk of developing frozen shoulder.

  4. Shoulder Injuries: A previous shoulder injury or surgery can increase the risk of developing frozen shoulder.

  5. Prolonged Immobility: Prolonged immobility of the shoulder joint due to injury, surgery, or illness can increase the risk of developing frozen shoulder.

  6. Certain Activities: Activities that involve repetitive overhead motions, such as playing tennis or painting, can increase the risk of developing frozen shoulder.

  7. Genetics: There may be a genetic component to the development of frozen shoulder, as it can run in families.

It’s important to note that while these risk factors may increase the likelihood of developing frozen shoulder, not everyone with these risk factors will develop the condition. In addition to these risk factors, the exact cause of frozen shoulder is not well understood. However, it is thought to be related to inflammation and thickening of the shoulder joint capsule, which can limit movement and cause pain.

Physiotherapy Treatment for Frozen Shoulder

Early treatment- if treated early, the patients would greatly benefit from rest, applying ice, compression, and elevation (RICE) over the inflamed area.

Physical therapy and home exercises recommended by the physiotherapist can be a first-line treatment for frozen shoulder, with consideration of the patient’s symptoms and stage of the condition. Physiotherapists may be able to suggest alternative ways of completing tasks that do not aggravate symptoms. In the frozen stage, the therapist may treat frozen shoulder with gentle, very specific periarthritis shoulder exercises. Working with a physiotherapist is very important at this stage as overdoing exercises or certain tasks can worsen the frozen shoulder.

Manual therapy technique like manipulation, mobilisation and body tissue massage may prove to be extremely helpful for frozen shoulder in the frozen stage.

Activities like lifting arms overhead, lying on side, or putting weight on leg can worsen the pain hence, exercises need to be supervised by a licensed physiotherapist. Physiotherapists are experts at exercise consideration that includes choosing an appropriate protocol, end point for test, intensity, duration as well as frequency needs to be considered. This enables keeping a comfortable range of motion with gentle exercises while focussing on keeping strength and mobility and taking care of the related or nearby areas.

In the last stages (resolution), the physiotherapist focus should on getting back to ADL(activities of daily life ) and increasing muscle tone and mass.

The therapist as required may use superficial heat or cold-Heat therapy that involves applying a dry or moist hot pack to the skin through a barrier (to minimise the risk of heart damage or burns). and waste elimination. A cold pack on warm skin draws heat from inflammatory tissues and limits swelling by constricting capillaries. Muscle relaxation, local anaesthesia, analgesia, and improved pain threshold are other effects. Depending on body type, these effects usually last 20–30 minutes. Cold packs for more than 30 minutes can damage skin and deeper tissues.

Activities that should be avoided if suffering from Frozen Shoulder

  • Do Not Skip Physical Therapy Sessions- Try to follow all of the physiotherapist’s directions. Avoid doing any type of activity without the supervision of a physiotherapist, since it may aggravate the disease.
  • Activities that Cause Pain should be avoided. Even though keeping shoulder mobile is important for healing and recovery, activities that involve pulls, sudden movement, or lifting should be avoided. These moves will only make the pain worse as they put undue stress on the muscles.
  • Incorrect posture and sleeping Position can affect the condition severely. A good posture whether standing or sitting can help avoid muscle tension, pain, fatigue, and many other common ailments and medical conditions. To help ease pain, shoulders should be kept back and slouching or slumping should be avoided. It is very important to visit a physiotherapist for treatment.

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