Frozen Shoulder

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What is a Frozen Shoulder?

Nobody really knows the cause of a frozen shoulder; it can begin after a knock or strain, bed rest, illness, but can also begin for no reason.  Although it can be very painful and cause difficulty, it is unlikely to leave you with long term effects.

The Shoulder Joint

There are 3 bones which make up the shoulder complex including the humerus (upper arm bone), clavicle (collar bone) and the scapula (shoulder blade). The three bones in the shoulder region form part of two main joints:

  1. The gleno-humeral joint between the glenoid of the scapula and the humerus.
  2. The acromioclavicular joint between the acromion of the scapula and the clavicle.

Most shoulder movement occurs at the gleno-humeral joint and it this part that becomes painful and stiff, affecting your normal function.

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What happens?

In a frozen shoulder, the capsule of the joint which is usually baggy on the underside to allow movement, becomes inflamed and tightens up. This therefore restricts movement of the shoulder.

How long does it take?

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A frozen shoulder can last between 6 months to 3 years, but in some cases can last longer.  It follows three stages, which do overlap somewhat:

  1. Freezing phase(Painful phase): acute inflammation causes worsening pain and progressive stiffness for 2 – 9 months. It may be felt on the outside of the upper arm but can extend down to the elbow and even into the forearm. It can be present at rest and is worse on arm movements. Sleep is often disrupted, as lying on the affected shoulder is painful or often impossible. During this phase, pain is the main feature but movements of the shoulder begin to reduce.
  2. Frozen phase: it will then plateau with consistent pain and stiffness for 4-12 months. The gleno-humeral joint becomes increasingly stiff, particularly on twisting movements such as trying to put your hand behind your back or head. These movements remain tight even when you try to move the shoulder with your other hand. It is the ball and socket joint which is stiff.
  3. Thawing phase: The pain and stiffness starts to resolve during this phase, and you can begin to use your arm in a more normal way. The total duration of the process is from 12 to 36 months, on average lasting 30 months.

General information

  • Generally affects 40-70 year old's
  • 70% of cases are women
  • Majority of affected limbs are non-dominant side
  • X-rays are completely normal
  • Linked to diabetes, thyroid disease, and some other conditions

What can help?

During the 1ststage– Physiotherapy and specific capsular stretches can help to maintain joint range of movement. Self-management techniques will also be taught with physiotherapy to use throughout the stages.

Anti-inflammatories, a steroid injection into the shoulder or a procedure known as a hydrodilatation can also be helpful. Speak to your physiotherapist or GP about these options.

During the 2ndstage- Physiotherapy can be helpful to continue to maintain range of movement in the shoulder. Analgesia, TENS or acupuncture can sometimes help with the pain and regaining some movement as a result.

During the 3rdstage– Your Physiotherapist can help to regain your movement and functional ability with a graduated exercise program.

In very severe cases with prolonged stiffness, there are other treatment that may be considered. You physiotherapist can discuss this with you.

Frozen shoulder is a self-limiting condition and symptoms will improve as it runs its course. Treatments outlined will help along the way. It is not a problem you should worry about and most of the time it will resolve without any lasting symptoms.

If you have any further queries or concerns about your symptoms, please speak to your GP or Physiotherapist.

The exercises 

Level one -The capsular stretches

There are four main movements which we use at the shoulder. These are flexion (move the arm forward), Abduction (move the arm out to the side), External rotation (rotate the arm outwards) and internal rotation (rotate the arm inwards – put your hand behind your back). Horizontal adduction (put the arm across your chest) is another key movement to stretch the posterior capsule.

We aim to regain these movements with specific stretches to the shoulder capsule. However, unlike muscular stretches, which are held for 30 seconds, capsular stretches are held for one minute and repeated 5 times to achieve the desired outcome.

When carrying out these stretches you may feel some discomfort at your shoulder. It is important that this pain does not exceed 3/10, where 10/10 is the maximal and 0/10 is no pain. There are three variations to do these stretches; one is that someone does them for you, such as your physiotherapist. The next is active assisted, where you use the other arm to provide the stretch either directly or using another object such as a stick. The other way is to stretch yourself as can be seen in videos below.

  1. Flexion: Facing a table head on, place your hands on top of towel or tea towel (to reduce friction) whilst on the table and slowly walk back feeling a stretch in your shoulder.

https://www.youtube.com/watch?v=ROwhLyRvCXA 

  1. Abduction: At 90 degrees to a table, place your hands on top of towel or tea towel (to reduce friction) whilst on the table and slowly lean away feeling a stretch in your shoulder.

https://www.youtube.com/watch?v=gBwhx4XM9LM 

  1. External Rotation: standing inside a doorway place your hand in the door frame and slowly turn away from the doorway, feeling the stretch in your shoulder.

https://www.youtube.com/watch?v=WXHlSoAEjMc 

  1. Internal Rotation: Holding onto a long towel, place this behind your back holding the top with your unaffected arm. Try to pull the affected arm behind your back as high as you can.

https://www.youtube.com/watch?v=ZQnw5RCLtOw 

  1. Horizontal adduction (posterior capsule): Place your affected arm across your chest as best you can and use your other arm to pull in further as far as you can.

 

Level two – Range of motion exercises for a stiff capsule.

Repetitions 15 - 25
Sets 3 – 5
Rest 30 – 60 seconds
Repeat per day 2 – 5

 

  1. Flexion

In a sitting position place your hand/hands on a table on top of a table cloth (anything to reduce friction). Slowly lean forwards allowing your arms to move forwards freely, using pain as your guide for the limit of movement. Return to starting position.

https://www.youtube.com/watch?v=tdBqcE4nwnI 

  1. Abduction

In a sitting position place your hand/hands on a table on top of a table cloth (anything to reduce friction) sitting at 90 degrees to the table.  Slowly lean sideward allowing your arms to move forwards freely, using pain as your guide for the limit of movement. Return to starting position.

https://www.youtube.com/watch?v=0bBh4CCczIg 

  1. Rotation

In a sitting position place your hand/hands on a table on top of a table cloth (anything to reduce friction) and your elbow bent to 90 degrees.  Slowly push your hand out to the side and back in towards your stomach, using pain as your guide for the limit of movement. Return to starting position.

https://www.youtube.com/watch?v=OdyGf-KCjE4 

  1. Eccentric lateral rotation.

Lying on your back with your arm bent to 90 degrees out to the side, just off the edge of a bend. Holding onto a light weight allow your hand to drop backwards, feeling a stretch at the front of your shoulder. Hold for 3 – 5 seconds and return to starting position.

https://www.youtube.com/watch?v=90kkOMwDASo 

  1. Trapezius stretch  

Begin sitting upright on a table grasping the edge with one hand. Rotate your head up and to the side of your anchored arm and slowly lean it toward your shoulder, applying pressure with your hand until you feel a stretch and hold. Make sure to keep your back straight during the exercise.

Hold 30 seconds and repeat 3 – 5 times.

https://www.youtube.com/watch?v=61al8UG6TeE  Logos.jpg  

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