The Frozen Shoulder by Clive Wincott
There are many different pathologies and injuries that affect the Shoulder Joint and Shoulder Girdle, too many to discuss in one blog post! So we’ve chosen today to talk about ‘Frozen Shoulders’ or ‘Adhesive Capsulitis’ as it’s medically known.
About your shoulder
The shoulder is designed to have a large amount of movement so that we can use our hands/arms in a wide variety of positions. Some movement occurs between the shoulder blade and chest wall. However most shoulder movements are at the ball and socket joint located at the top of the upper arm bone (humerus).
What is ‘frozen shoulder’?
Frozen shoulder is a condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the cause is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, which can last up to approximately 1 to 3 years’, though incomplete resolution can occur.
Typically the joint is stiff and initially painful; the loose bag (capsule) around the shoulder joint becomes inflamed. The bag then appears to tighten, shrink or become stuck to itself. Hence it’s clinical name of ‘Adhesive Capsulitis’. This tightening combined with the pain limits movement.
How common is it?
It is most common in people between the ages of 40 and 70 years and has been estimated to affect at least one person in 50 every year or 3% of the population. A staggering one million people in the UK will have frozen shoulder in a year. It normally affects the non-dominant shoulder first. About 10% of people may develop frozen shoulder in the other shoulder within 5–7 years of the first one. However it tends to resolve far quicker than the first. It is more common in people with diabetes and with those who have a thyroid gland problem. 90% of patients with a frozen shoulder will regain normal range of motion.
What is likely to happen?
There are 3 main phases:
- Painful phase (which can last from 2 to 9 months) or ‘Freezing’
The pain often starts gradually and builds up. It may be felt on the outside of the upper arm and can extend down to the elbow and even into the forearm. It can be present at rest and is worse on movements of the arm. Sleep is often affected, as lying on it is painful or impossible. During this time movements of the shoulder begin to be reduced, in particular reaching and putting on jackets.
- Stiff phase (which can last from 4 to 12 months) ‘Frozen’
The 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 even when you try to move the shoulder with your other hand or someone tries to move the shoulder for you. It is the ball and socket joint which is stiff. The shoulder blade is still free to
move around the chest wall, and you may become more aware of this movement. E.g. Driving, dressing, sleeping are commonly affected.
- Recovery phase (which can last from 5 to 26 months) ‘Thawing’
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 42 months, on average lasting 30 months.
What can be done?
Pain relief and NSAIDS like Ibprofen are normally recommended. TENS for pain relief. Early range of movement exercises are encouraged and Physiotherapy to help prevent further decrease in range of movement and help to improve and regain range of movement in the shoulder.
Your GP or Shoulder Surgeon may offer you a Cortico-steroid injection into the shoulder joint, this combined with Physiotherapy can be very effective. However, If you have significant pain and stiffness, doctors may refer you for either a Manipulation under Anaesthetic ’(MUA) plus arthroscopy operation, or a distension procedure which tries to stretch the capsule (which is now tight) around the shoulder joint. The tight capsule may be released or removed. In addition the joint is stretched in certain directions to try and free the joint up.
An assessment of your shoulder will be completed, and from this, an individual treatment programme will be devised including manipulation, mobilisation and soft tissue techniques; Exercises will be given for not only the shoulder joint, but also the shoulder girdle (shoulder blade) and thorax (ribs and upper back) These may include exercises to strengthen the muscles around your shoulder blade, improve your posture, stretching exercises and/or strengthening the rotator cuff. Although the exercises may be hard work, tight or uncomfortable, they should not be painful. If you are unable to do any form of exercise because of pain, the physiotherapist may offer treatments such as ultrasound or taping techniques. Thorough assessment of your arm, advice and exercises are probably more important aspects of the treatment.
The aims of the treatment are:
Reduce the stress on the tendon(s), loosen the capsule and stretch out surrounding soft tissues so that your body can try and heal the area and to break the pain cycle.
If you are in any doubt about your shoulder pains, contact your local GP.
More importantly give us a call here at Pea Green Physio, and with your help we can get you back on track, and grasping the opportunities that you want to do in life!!
Call 01869241411 to book in for an assessment TODAY!
SPECIALISTS IN … ahhh that’s better!
by Clive Wincott – MSk Physiotherapist
Pea Green Physio