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Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder becomes painful and stiff. Do not be fooled with the name of “frozen” shoulder, because this condition can occur at any time throughout the year. Frozen shoulder can occur after a minor injury to the shoulder but often occurs out of nowhere. Risk factors for developing frozen shoulder include the following: having thyroid disease or diabetes mellitus, age 40-65 years old, female sex, and having a previous episode of frozen shoulder in the other arm. In an MRI, some components of frozen shoulder can include thickening of some of the shoulder structures, joint volume reduction, and proliferative synovitis surrounding the shoulder ligaments.
The pain and stiffness caused by frozen shoulder can affect your ability to perform everyday activities such as getting dressed, brushing your hair, reaching to a shelf or cabinet, driving, cleaning, and so forth. For women, a main complaint is having difficulty with putting on/taking off a bra. There may be pain at rest as well, including difficulty with sleeping at night. The problem usually lasts 1 to 2 years; however, physical therapy has been shown to help decrease the pain and improve the motion and function of your shoulder.
The timeline of frozen shoulder has been nicely broken down into four phases:
• Phase 1: 0-3 months, “Pre-Freezing Stage”: In this stage you may have sharp pain at end ranges of shoulder motion, achy pain at rest, and your sleep may start to be disturbed. Range of motion is not significantly affected yet.
• Phase 2: 3-9 months, “Freezing Stage”: You may start to notice that your shoulder range of motion is starting to become more limited because of pain.
• Phase 3: 9-15 months, “Frozen Stage”: In this stage, there is moderate pain and loss of shoulder range of motion.
• Phase 4: 15-24 months, “Thawing Stage”: Shoulder pain will begin to resolve, but significant stiffness may persist.
These phases of frozen shoulder are not a “one size fits all” categorization, and many people will see improvement in pain levels and range of motion once initiating in a physical therapy program. A thorough evaluation will help determine an individualized treatment approach for your shoulder. Education on the condition in addition to what phase you are currently in will be discussed. Once this is determined, your physical therapist will help decide what intensity of stretching, mobility exercises and joint mobilizations are appropriate for you. It is important to note that with this condition, although the shoulder may be stiff and painful, you should continue to move the shoulder and stretch, as this will help speed up your healing. Furthermore, it has been found that a corticosteroid injection in combination with physical therapy may help to reduce the inflammatory response and reduce pain.
These exercises/stretches below can be attempted to loosen the shoulder capsule.
1) Pendulums: Setup: Begin in a standing position with your trunk bent forward, one arm resting on a table for support and your other arm hanging toward the ground. Movement: Slowly shift your body weight in a circular motion, letting your hanging arm swing in a circle at the same time.
2) Internal Rotation Towel Stretch: Setup: Begin in a standing position, holding both ends of a towel in each hand, with one arm behind your head and the other behind your mid to low back. Movement: Slowly straighten your upper arm, gently pulling upward on the towel, and hold when you feel a stretch.
Frozen shoulder can sound like a daunting diagnosis, especially with the amount of time that it may take to fully recover. However, a patient once told me, “Motion is lotion,” and this could not be more applicable to this diagnosis. Knowing what exercises/stretches to perform will be integral to your recovery. For more information on the treatment of frozen shoulder, contact us at either of our offices or send an email to me at jfilzen@dborthopt.com
References:
Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013 May;43(5):A1-31. doi: 10.2519/jospt.2013.0302. Epub 2013 Apr 30. PMID: 23636125.
