You're probably thinking of a frozen shoulder when you hear it. The condition also known as adhesive capsulitis is when the shoulder capsule becomes stiff and inflamed. This condition can be painful and cause a reduced range of motion in the shoulder. It may feel like your shoulder is frozen.
Causes of frozen shoulder
According to Dr. Thomas Throckmorton (a professor at the University of Tennessee-Campbell Clinic, Germantown, Tennessee), health providers are often unaware of what causes frozen shoulder. Some causes are a shoulder injury, or the immobilization of your shoulders for a prolonged period. Your arm may have been in a cast for a long time, or your upper body had surgery and you couldn't move your shoulder much.
Females between the ages of 40 and 60 are more likely to have frozen shoulders. It affects between 2% and 4% of people over 40. People with certain conditions such as diabetes, heart disease, and other health issues are more likely to experience frozen shoulder.
Thyroid disease. Thyroid disease may be more common among those with thyroid disease. This is due to increased inflammation.
A frozen shoulder in someone suffering from diabetes is often associated with uncontrolled sugars. Dr. Anthony Miniaci, an orthopedic surgeon and deputy chief executive at Baptist Health Orthopedic Care, Florida, said that it is common for people to have uncontrolled sugars. He actually helped to diagnose diabetes in a patient with diabetes who was not aware of it. A blood sugar level check revealed that the patient had frozen shoulder.
Anecdotally Theresa Marko is a board-certified clinical specialist orthopedic physical therapy and owner of Marko Physical Therapy, New York City. She has noticed that frozen shoulders tend to be more common in people who are experiencing stressful times in their lives. This could be because of increased inflammation during stressful times.
Diagnosis and symptoms of frozen shoulder
The following symptoms can be indicative of frozen shoulders:
You may experience a reduced range of motion when performing certain moves that involve your shoulders. Marko states that this can make it more difficult to perform certain activities, like reaching the top shelf, washing your head, or picking up something. It can also make it more difficult to dress and apply deodorant.
The symptoms of frozen shoulder can be confused with other conditions such as:
Shoulder impingement is when your upper shoulder blade touches the rotator wrist below it.
Health providers will conduct a medical history and a physical exam to determine the exact cause of stiffness or inflammation. These, along with any presenting symptoms, can often lead to a diagnosis. A health provider might order an MRI, X-ray, or both to diagnose frozen shoulder. However, experienced clinicians may not need imaging.
The Phases of Frozen Shoulder
Three phases are involved in frozen shoulder:
This is when the shoulder becomes stiff and painful. According to Mayo Clinic, this can take between two and nine months. The frozen stage can cause pain, but the shoulder will become stiffer. The shoulder will regain its motion within 5 to 24 months.
Treatments for Frozen Shoulder
The following are some treatments for frozen shoulders:
The recovery process for frozen shoulder is long. It can improve in as little as a year or take up to three years. Amanda Steward, Strive Physical Therapy's physical therapist, said that it is possible for the shoulder to heal.
Throckmorton states that patients need to be aware that non-surgical or surgical treatment may not always provide a quick fix.
Frozen shoulder can be self-limiting, so it won't get better if active treatments are not used. However, there are many treatments that can reduce your pain and help you manage your symptoms.
At-Home Pain Relief
There are several at-home treatments available for frozen shoulders:
Massage by a professional or self-massage This can loosen tight muscles and other areas of the body. Topical creams and lotions that relieve pain.
Miniaci states that although these at-home treatments will not make the frozen shoulder go away faster, they can help alleviate any discomfort.
Cortisone Injection and Hydrodilatation/Hydrodissection
To reduce stiffness and inflammation, a doctor can give a cortisone injection to treat frozen shoulder. Although the shot can help for up to six months, it will not be able to treat all symptoms. You should consult your doctor if you have diabetes to determine if a cortisone shot is right for you. It can increase blood sugars.
Hydrodilatation, or hydrodissection is another option. This involves injecting saline into the joint and expanding the ligaments to stretch them. Miniaci will then follow this up with a cortisone shot.
For frozen shoulder, surgery is rare. A surgical intervention is only necessary if other treatments fail to work. "Manipulation under Anesthesia" is the most common type of surgical procedure. The surgeon will make the shoulder move and cause the scar tissue and capsule to stretch. According to the American Academy of Orthopaedic Surgeons, this can loosen tightening and increase range of motion.
The second procedure is shoulder surgery, also known as a'scope'. During this procedure, a surgeon will remove the tight areas of the joint capsule. Sometimes both procedures can be done simultaneously.
Usually, surgery for frozen shoulder is successful. Miniaci admits that it is possible for frozen shoulder symptoms and signs to return after surgery. Miniaci says this is why he recommends surgery as an option for frozen shoulder.
A physical therapist can help you treat your frozen shoulder.
To help you maintain the benefits of your in-person sessions, the physical therapist will show you exercises that you can do at home.
To help people with frozen shoulders, physical therapists employ a variety of techniques:
Trigger point release is a technique that uses massage or another techniques to relieve tension and pain.
Physical therapy exercises can be used to improve your tolerance for symptoms such as frozen shoulder. You may also be able to get help from a physical therapist to strengthen your shoulder. Marko suggests that you can do light strength training if your shoulder is frozen. This includes arm movements that involve your triceps and biceps. Throckmorton says that intense strength building should wait until you feel more comfortable and have less pain.
Marko recommends that you follow the advice of your physical therapist for muscles such as the deltoids or external rotators. This will allow you to move in your full range of motion and not strain your joints. A physical therapist can also help you regain strength after muscle weakness that results from not being able to move your arm for long periods.
Exercises to treat frozen shoulders
Your motto should be "No pain, no gain". Follow the home exercises provided by your health provider to match where you are at the frozen shoulder stages. If you have frozen shoulders, the exercises below will be appropriate for you.
The affected arm should be hung down towards the ground. For up to two minutes, move the affected arm around in circles or side-to-side. Do not squeeze your shoulder blades. Your shoulder blades should be squeezed back. Lay down on the ground using a cane, or a longer umbrella. You can hold the umbrella or cane in your hands and then move your arms back towards your ears. To move further, the non-affected side should be guiding the side with frozen shoulder. You should go as far as possible to feel a stretch, but not pain. Repeat this five times. Marko states that the lying-down-cane exercise is a great way to relax and allow gravity to open your shoulder.
A Final Word on Frozen Shoulder
It is possible for a frozen shoulder to recur on another shoulder. Throckmorton states that this happens in 20-25% of patients. Your shoulders can be kept healthy by regular range-of motion stretches, exercise and healthy eating habits. These steps won't prevent future problems, but they can help.
Do the exercises at home, see a physical therapist when you are unable to do them and take what pain relief you need.
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This article was published previously at a earlier date. It has been updated with new information.
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Theresa Marko, DPT and PT
Marko is a board certified clinical specialist in orthopedic and physical therapy. He also owns Marko Physical Therapy in New York City. Marko is also a spokesperson for American Physical Therapy Association Media Corps.
Anthony Miniaci, MD
Miniaci, an orthopedic surgeon and deputy chief executive at Baptist Health Orthopedic Care Florida, is also known as Miniaci.
Amanda Steward, PT, DPT, OCS
Steward is a Strive Physical Therapy physical therapist. The company has several locations in New Jersey, Pennsylvania.