What to do about a frozen shoulder

Adhesive capsulitis, more commonly known as a ‘frozen shoulder’, is a painful condition that is characterised by stiffness and a loss of motion in the shoulder. What causes frozen shoulder, what can you do about it and how can you stop it from happening in the first place? Let’s take a look!

 What is a frozen shoulder?

The tissue that surrounds the shoulder joint and holds it together is called the capsule - when this becomes inflamed, this band of tissue becomes stiff, which restricts the movement of the shoulder.

There is no clear cause of frozen shoulder, however hormonal imbalances, diabetes or a weakened immune system can make you more susceptible to joint inflammation. Long periods of inactivity following injury, illness or surgery also increase the chance of a stiff shoulder joint.

What are the symptoms of a frozen shoulder?

If you develop adhesive capsulitis, you are likely to experience symptoms in three stages across a period of approximately 1-3 years.

Initially, the shoulder will be intensely painful, and any movement will cause pain. At this stage, movement begins to become limited. The discomfort often leads to avoiding moving the shoulder, which further increases the stiffness.

When the shoulder is at its most stiff, pain may reduce somewhat, but movement becomes more difficult.

Once the shoulder begins to “thaw”, the range of motion then improves.

Many people say that the pain is worse at night and can keep them awake.

How do you treat a frozen shoulder?

Physiotherapy is the most common treatment for a frozen shoulder. A physio will help you to stretch your shoulder joint to recover the range of motion and will teach you a program of gentle exercises to do at home.

While you’re waiting for your physio appointment, putting an ice pack on the shoulder for 15 minutes, several times a day, can help to reduce the pain.

Another method, is to place a hot pack in your arm pit. This allows the heat to concentrate deep inside the shoulder joint, acting directly on the rotator cuff muscles.

Both heat and cold stimulate heat shock proteins (HSP) which are the basic building blocks of life and the immune system. Hence, important in soft tissue repair as well as the modulation of the immune response.

Taking a high concentration of EPA/DHA fish oil can reduce some of the inflammation and improve blood flow. Importantly, it's the 2000mg of the EPA/DHA which is the active ingredient of fish oil. Check the label of your fish oil for this concentration. Additionally, make sure their are low levels of mercury and other potentially toxic ingredients in your fish oil.

Other anti-oxidant anti-inflammatories include tumeric, forest berries, etc.

If you opt for an invasive procedure such as an injection then this must be done with imaging and go into the joint capsule. Sometimes, a severe subacromial bursitis can mimic a 'frozen shoulder' where an injection could be made there instead.

Further differential diagnosis with a nerve condition from the cervical spine should also be undertaken, where a diagnosis of 'frozen shoulder' isn't clear. Normally, the history of gradually worsening, night pain and loss of range of movement with flexion at 60 degrees, abduction at 30-45 degrees, 1/4 external rotation and almost no internal rotation (hand behind back) is usually indicative of a 'frozen shoulder. Testing those movements with the head and neck in lateral flexion (side bending) could help to differentiate a neck pathology contributing to the clinical presentation. Frequently, their a familial (genetic) tendency to 'frozen shoulder'. Whilst teaching in Japan, I saw a lot of 'frozen shoulders' whereas during the 10 years in Switzerland I saw almost none.  

Who is at increased risk of a frozen shoulder?

The following people are at greater risk of developing adhesive capsulitis:

• Those over the age of 50
•  Women
• People with diabetes
• People with thyroid conditions
• People with cardiovascular disease
• Previous shoulder injury
• Anyone who has to remain still for long periods of time due to illness or surgery
• Anyone who needs to wear a shoulder sling for a long period of time following an injury 

What can you do to prevent a frozen shoulder?

As immobility is a major cause of a frozen shoulder, if you suffer an injury or illness that will keep you out of action for a while, speak to a physiotherapist about exercises that you can do safely to keep your shoulder moving.

If you’re experiencing pain or loss of motion in your shoulder, give us a call on 02 9922 6806 or email us and we’ll talk to you about how we can help.

Further reading on shoulder pathology : https://www.back-in-business-physiotherapy.com/we-treat/shoulder-problems.html 

 References

1. Mayo Clinic. 2020. Frozen shoulder [Onlinehttps://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684
2. Healthline. 2016. Frozen Shoulder [Onlinehttps://www.healthline.com/health/frozen-shoulder

Uploaded : 23/07/2021