INTRODUCTION
Frozen shoulder, or Adhesive Capsulitis, is a condition where the shoulder joint becomes stiff and painful, limiting movement. Recovery can take 2–3 years, but physiotherapy is key to easing pain, improving flexibility, and restoring mobility. With patience, proper care, and the right exercises, you can manage the discomfort and regain full movement over time.
Risk factors
Frozen Shoulder: What You Should Know
- How Common Is It?
Frozen shoulder affects 2%–5% of people, mostly between 35 and 65 years old.
- Who’s at Risk?
Women are more likely to develop it, with 70% of cases occurring in females.
- Why the Name “50-Year-Old Shoulder”?
It’s most common around age 50, especially in countries like China and Japan.
- Which Arm Is Affected?
It often impacts the non-dominant arm, though both shoulders can be affected in about 14% of cases.
- Can It Affect Both Shoulders?
There’s a 5%–34% chance of it happening to the opposite shoulder later.
- What Increases the Risk?
Autoimmune conditions like thyroid disorders or diabetes increase the chances. About 20% of diabetics develop frozen shoulder.
Understanding these points can help you identify the condition early and seek proper treatment!
Causes
Frozen shoulder can be classified into two types:
- Primary Frozen Shoulder:
This type has no known cause. It develops on its own without any clear reason. - Secondary Frozen Shoulder:
This type occurs due to a specific cause or risk factor. It can happen after surgery, a stroke, or an injury. For example, after an injury, a person might move their shoulder differently to avoid pain. This change in movement can lead to stiffness and a reduced range of motion in the joint over time.
Signs and Symptoms
- Onset of Symptoms: Gradual shoulder pain
Patients typically experience shoulder pain that develops slowly over several weeks to months.
- Progression of Symptoms: Significant limitations in shoulder motion
As the condition worsens, patients face notable restrictions in their shoulder movement.
- Key Clinical Sign: Reduced active and passive range of motion (ROM)
There is a decrease in shoulder motion, particularly in Forward flexion, Abduction, External rotation and Internal rotation
- Severe Cases: Loss of arm swing and muscular dystrophy
In more advanced cases, patients may lose the natural swinging motion of their arms while walking, and there may be signs of muscular dystrophy.
- Tenderness: Diffuse tenderness upon palpation
Palpating the affected shoulder reveals widespread tenderness around the shoulder joint.
Stages of Frozen Shoulder
- Freezing Stage
- Symptoms: Gradual onset of severe shoulder pain, especially with movement, and difficulty finding a comfortable position, especially at night. Stiffness increases over time.
- Duration: 2–9 months.
- Treatment:
- Focus on pain control and reducing inflammation with medications like acetaminophen or NSAIDs (limited effectiveness). Severe cases may require stronger painkillers.
- Physical therapy with gentle stretching, manual therapy, and techniques like ultrasound or TENS.
- Daily home exercises to maintain movement.
- Frozen Stage
- Symptoms: Pain begins to decrease, but stiffness persists. Movement is significantly limited, especially in specific directions (e.g., forward, outward, and rotation).
- Duration: 4–12 months.
- Treatment:
- Physical therapy to improve range of motion.
- Corticosteroid injections for moderate to severe pain, guided by imaging for accuracy.
- Rehabilitation exercises after injections to aid recovery.
- Thawing Stage
- Symptoms: Gradual improvement in stiffness and shoulder function over time.
- Duration: 5–24 months. In some cases, full recovery can take up to 3 years.
- Treatment:
- Continued physical therapy with more intense exercises to restore mobility.
- If no improvement after 6 months of therapy, advanced treatments like capsular stretching, manipulation under anesthesia, or arthroscopic surgery may be needed.
While most recover fully, some patients may experience lingering symptoms, with 15% facing long-term pain and reduced mobility. Early treatment and consistent care are crucial!
Recommended Exercises and Useful Tips for Every Phase of Frozen Shoulder Recovery
Freezing Phase
During the freezing phase, focus on gentle exercises to relieve pain and maintain mobility.
Here’s how you can help yourself:
Pain-Relieving Exercises
- Pendulum Exercise:
– Lean forward, letting your arm hang down.
– Gently swing your arm in small circles or back and forth.
- Passive Supine Forward Elevation:
– Lie on your back and use your good arm to lift the affected arm upward slowly.
- Passive External Rotation:
– Sit or stand and gently rotate your affected arm outward with the help of your other hand.0
- Active-Assisted Movements:
– Use a stick or your other arm to assist in moving your shoulder through a comfortable range.
Stretching Exercises
- Neck and Shoulder Stretches:
– Slowly tilt your head side to side and roll your shoulders backward to release tension.
Useful Tips
- Heat or Ice Packs: Apply a heat pack before exercising to relax muscles or an ice pack after to reduce soreness.
- Short Sessions: Keep exercises short (1–5 seconds) and focus on a pain-free range.
- Good Posture: Sit or stand upright to avoid strain and maintain shoulder flexibility.
- Gentle Approach: Don’t push through pain. Stretching should feel mild, not painful.
What to Avoid
- Avoid aggressive stretching or movements that worsen pain.
- Prevent slouching or poor posture, which can affect shoulder recovery.
Frozen Phase
During the frozen phase, pain decreases, but stiffness persists. Focus on gentle pain relief and exercises to maintain strength and mobility.
Gentle Home Exercises
- Stretching Exercises:
– Stretch your chest muscles by clasping your hands behind your back and gently lifting them.
– Stretch the back of your shoulder by bringing your affected arm across your body and gently pulling it closer with your other hand.
- Rotation Before Elevation
– Perform external rotation stretches first (e.g., use a stick or your other hand to gently rotate your arm outward) to reduce discomfort before overhead exercises.
Strengthening Exercises
- Isometric (Static) Contractions
– Place your hand against a wall and push gently without moving your shoulder.
– Hold for a few seconds and release.
- Scapular Retraction
– Sit or stand upright. Gently squeeze your shoulder blades together as if pinching a pencil between them. Hold for 5 seconds and relax.
- Isometric Shoulder External Rotation
– Press your affected arm gently outward against a surface (like a wall or your other hand) without moving it. Hold for 5 seconds and release.
Important Tips
- Apply heat packs before exercises to relax muscles or ice packs afterward to reduce any soreness.
- Stick to gentle movements and avoid pushing through pain.
- Focus on small, controlled motions to avoid aggravating the shoulder.
- Maintain good posture during exercises to prevent strain.
Thawing Phase
During the thawing phase, your shoulder gradually regains motion and strength. Focus on rebuilding strength and restoring full mobility with consistent, gentle exercises.
Pain Relief
- Apply heat packs before exercises to relax muscles or ice packs afterward to soothe any discomfort.
Home Exercises
- Perform gentle mobility exercises to stretch and regain motion, such as:
– Pendulum swings for flexibility.
– Chest and arm stretch to improve range of motion.
- Gradually increase the stretch duration as tolerated.
Exercise Recommendations
- Focus on mobility exercises to restore range of motion.
- Transition to strengthening exercises, starting with light resistance.
Types of Strengthening Exercises
- Resistance Band Workouts:
– Use a band to perform gentle pulls, external rotations, or lateral raises.
- Light Weightlifting:
– Use small dumbbells for controlled arm lifts or shoulder presses.
- Rotator Cuff Strengthening:
– Perform external and internal rotations using resistance bands or light weights.
- Posture Exercises:
– Sit upright and squeeze your shoulder blades together for a few seconds.
- Deltoid and Chest Workouts:
– Wall push-ups or dumbbell presses to strengthen these muscles.
Choo Yee Ning
Physiotherapist
Your Physio Bukit Mertajam