Having a frozen shoulder is one of the most annoying complaints our patients tell us here at the Joint Pain Clinic. Due to the recurrent and ongoing pain and stiffness in the shoulder blades we regard this a very serious issue. If it is left untreated it can cause many secondary problems. This condition is clinically known as adhesive capsulitis, it was initially called scapulohumeral periarthritis, and it is commonly associated with a process called arthrofibrosis.
A frozen shoulder is likely to happen in patients with prolonged shoulder immobility, as in patients who need to wear a cast or those who are recovering after surgery. This often promotes the formation of adhesion and scar tissue leading to the characteristic pain and stiffness in the articulation. In this article, we are going to cover the diagnosis and possible causes of a frozen shoulder, what can we do about it at home.
The Dreaded Frozen shoulder: Causes and Diagnosis
There are two types of adhesive capsulitis (aka. Frozen shoulder) according to the causes. There’s primary adhesive capsulitis, which is often referred to as idiopathic adhesive capsulitis, and secondary adhesive capsulitis. The former develops spontaneously without any trauma or immobilization of the articulation while the latter results from trauma and it is a severe complication of shoulder arthroplasty and other types of arthroscopic procedures in the articulation of the shoulder.
In every case, the first thing that usually appears is inflammation of the synovial membrane that surrounds the articulation of the bone joint. In time, ongoing inflammation promotes the formation of adhesion in the joint and capsular contractures. In the final stage of the disease, the inflammation in the synovial membrane might be absent, but it is replaced with adhesions and extensive fibrosis of the articulatory tissue.
However, feeling stiffness and pain in the shoulder blades alone and feeling “a frozen shoulder” does not mean you are suffering from adhesive capsulitis. This problem affects less than 5% of the population in the UK, but it has a higher risk in certain patients, especially those undergoing shoulder surgery, prolonged immobilization in the articulation, and those who have diabetes.
Adhesive capsulitis usually starts with shoulder pain, especially at night, and mobilization problems usually come afterward. Patients may detect a gradual loss in the range of motion as the shoulder tissue starts undergoing fibrosis. External rotation (which is rotating your shoulders away from your torso) is often the first movement to be affected by this condition, and when you reach the limits of your movements, pain usually becomes worse and would not let you go further.
Before diagnosing adhesive shoulder capsulitis, your doctor might need to rule out other possibilities, such as rotator cuff pathologies, an incorrect fracture repair, septic arthritis, and a few others. Thus, if you have the symptoms described above, it is essential to ask your doctor before reaching any definite conclusion.
What can I do to find relief from the Pain?
Adhesive capsulitis is often self-limiting, and the symptoms tend to resolve themselves after 3 years, but having this pain and stiffness for such a prolonged period of time might become a severe limitation to your day-to-day activities such as working in a job, and many patients have reported long-lasting symptoms. That’s why there are surgical and non-surgical options to choose from depending on your symptoms and prognosis. But regardless of medical procedures, if you have been diagnosed with a frozen shoulder, there are several stretching exercises and a few home remedies you can follow to improve your symptoms.
You can follow these instructions and the following succession of exercises designed by the Harvard Medical School to improve your symptoms:
- Over-the-counter medications: The most common approach to improve the pain associated with a frozen shoulder is through over-the-counter painkillers. Ibuprofen is one of the commonly prescribed drugs, but in more advanced cases your doctor might consider other options such as corticosteroids and surgery. It widely depends on your symptoms and the progression of your individual condition.
- Heat and warm up: According to an article published in the Journal of Rehabilitation Medicine, applying deep and superficial heating to relief frozen shoulder symptoms is one way to improve patient’s performance in their day-to-day activities when combined with stretching exercises. Thus, our first recommendation is to apply heat in the affected shoulder for 15 minutes using hot packs or a warm bath while performing circular movements without reaching the limits of your range of motion or triggering pain. The objective is to lubricate the articulation and stimulate your blood flow before starting to perform the stretching exercises.
- Pendulum stretch: The first stretch is performed in a standing position and leaning down slightly letting the affected arm hanging and performing swinging motions describing a small circle. Complete 10 circles in one direction and 10 circles in the opposite. The objective is to make bigger circles as your symptoms improve without making forceful movements.
- Towel Stretch: Hold a towel behind your back with both hands on each end. Then, pull upwards gently with your healthy arm to stretch your affected shoulder. Relax and repeat this motion 10 to 20 times. What we are trying to do is achieve a passive stretching of your shoulder, which is similar to the motions performed in physical therapy.
- Finger walk: Stand in front of the wall and place your hand touching the wall with your fingers. Using your fingers and relaxing your shoulders, walk upwards in a spider-like motion as far as you can without forcing yourself. Lower the arm and repeat 20 times. Similar to towel stretch, we are trying to perform a passive stretching without triggering pain.
- Cross-body reach: Lift your affected arm across your body and hold it with your healthy arm. Keep it leveled with your elbow and apply gentle pressure to the side holding there for 15 seconds and repeating 20 times. This is a common stretch movement in sports, and it is very useful to stretch your affected arm inwards.
- Armpit stretch: Lay the affected arm on a shelf keeping it leveled with your chest. Keep it there and bend your knees to stretch the armpit as far as you possibly can without forcing yourself. Straighten and repeat the movement 20 times a day. This is another passive movement that is made to stretch your affected arm upwards.
- Strengthening exercises: When you start noticing an improvement in your range of motion by doing the previous exercises every day, you may begin with strengthening exercises, but make sure to warm up first. Use a rubber band, hold it with both hands and use the affected arm to perform outward rotations moving your forearm only. To strengthen your inward rotation, you may hook the rubber band to a doorknob and perform the same movement towards your body.
Frozen Shoulder Check List
| Frozen Shoulder (adhesive capsulitis) | |
| Risk factors | Arthroscopic surgery, prolonged immobilization, diabetes |
| Causes | Synovitis, adhesions, and fibrosis of the shoulder articulation |
| Symptoms | Starts with shoulder pain and continues with progressive limitation in the range of movement with increasing pain when reaching the limits |
| Action | Over-the-counter medications, external heating and warming up before performing stretching exercises |
| Exercises | Pendulum stretch, towel stretch, finger walk, cross-body reach, armpit stretch, and strengthening exercises. |
References:
Harvard Publishing. (2014). 7 stretching & strengthening exercises for a frozen shoulder – Harvard Health. Retrieved from https://www.health.harvard.edu/shoulders/stretching-exercises-frozen-shoulder
Manske, R. C., & Prohaska, D. (2008). Diagnosis and management of adhesive capsulitis. Current reviews in musculoskeletal medicine, 1(3-4), 180-189.
Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & elbow, 9(2), 75-84.
Leung, M. S., & Cheing, G. L. (2008). Effects of deep and superficial heating in the management of frozen shoulder. Journal of rehabilitation medicine, 40(2), 145-150.
