Frozen Shoulder | Diagnosis and Treatment

Frozen Shoulder:

In Frozen shoulder Typically joint is stiff and initially painful, often starting without an apparent cause. In patients suffering with frozen shoulder the loose capsule around the shoulder joint becomes inflamed the bag then appears to tighten or shrink, this tightening combined with pain restricts movement. This condition is termed as Frozen shoulder also called as adhesive capsulitis.

Frozen Shoulder: Causes, Symptoms, Treatment and Diagnosis
Frozen Shoulder Test

Age Ratio:

It is most common in people between ages of 40-70 years.
10% of people may develop frozen shoulder in other shoulder within 5-7 years of the first one but more quickly resolved than first one.

Frozen Shoulder Causes:

Frozen shoulder is common in people with diabetes & thyroid problem
15% of patients link with minor shoulder injury.
Major injury or surgery to shoulder.

Symptoms of frozen shoulder:

Severe pain in shoulder
ROM limited
Stiffness in shoulder
Difficulty in ADL’s
Restricted flexion
Restricted extension

Frozen shoulder test:

  • X-ray
  • Ultrasound
  • Imaging test
  • MRI

Phases of Frozen Shoulder:

There are three main phases in frozen shoulder:

  • Painful phase
  • Stiff phase
  • Recovery phase

Painful Phase:(2 to 9 months)

Pain often starts gradually and builds up, it may be felt on outside of the upper arm and can extend down to elbow and even in forearm. Pain is even present at rest and is worse during arm movements. Sleep is often affected as lying on it is painful or impossible during this time movements of shoulder begin to be reduced.

Stiff Phase:(4 to 12 months)

Ball and socket joint becomes increasingly stiff, particularly on twisting movements such as trying to put your hand behind your back or head. These movements remain tight when you try to move your shoulder with your other hand or someone tries to move the shoulder for you. It is the ball and socket joint which is stiff, shoulder blade is still free to move around the chest wall, and you may become more aware of this movement.

Recovery Phase:(5 to 26 months)

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 process is from 12 to 42 months, on average lasting for 30 months

Treatment Options:

  • During painful phase emphasis is on pain relief therefore pain killing tablets and anti inflammatory tablets may be prescribed.
  • Apply heat such as hot water bottles or cold (ice packs)
  • Injections into the joint may also be offered.
  • Physiotherapy at this stage is directed for pain relief.
  • TENS machine or acupuncture therapy.

Surgery:

If you have significant pain and stiffness the doctor may offer you a manipulation under anesthetic plus arthroscopy operation. There is a separate information leaflet on it. In addition the joint is stretched in certain directions to free the joint.
This operation is not done routinely for frozen shoulder, only for those who are very slow to resolve.

Exercises:

Following are some examples of exercises to stretch your shoulder which might be changed for your particular shoulder.

  • Do exercises regularly 1-2 times a day.
  • It is normal to feel aching or stretching sensation when doing these exercises. However severe and lasting pain like more than 30 minutes is not recommended.
  • If pain is severe discontinue exercises and see physiotherapist or doctor.

1.Pendulum:

  • Lean forward with support  (for left shoulder)
  • Let arm hang down.
  • Swing arm in forward, back, side to side and in circle.
  • Repeat 5-10 times each movement.

2.Twisting outwards:

  • Sitting holding a stick.
  • Keep elbow into your side throughout.
  • Push with unaffected arm, so hand of affected side is moving away.
  • Do not let your body to twist round to compensate.
  • Repeat 5-10 times.

3.Arm over head:

  • Laying on your back.(left shoulder)
  • Support affected arm with other hand at wrist and lift it up over head.
  • Do not let your back arch.
  • Repeat 5-10 times.

4.Kneeling on all fours:

  • Keep your hands still.
  • Gently sit back towards your heels.
  • Repeat 5-10 times.

5.Hand Behind Back:

  • Standing with arms by side.
  • Grasp wrist of affected arm.
  • Gently stretch hands towards opposite buttock.
  • Slide your arm up your back.
  • Can progress and use a towel.
  • Repeat 5 times.

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