Frozen Shoulder
Anatomy of Frozen Shoulder
The shoulder joint capsule gradually stiffens due to scar tissue (called adhesive capsulitis) with progression to involve surrounding tissues.
Typical History
Gradual onset of worsening shoulder pain and stiffness with reduced range of motion in multiple directions.
Factors That Contribute to Frozen Shoulder
In many cases no specific cause can be identified. Correlations have been found with immobilization following injuries, mastectomies/chest surgery, heart disease, diabetes, hyperthyroidism, chronic lung disease, shoulder arthritis, nerve impingement in the neck and chronic tendonitis. In most cases an inflammatory process leads to scar tissue thereby triggering frozen shoulder.
Your doctor will examine the shoulder looking for a specific pattern of reduced motion which is referred to as a capsular pattern (abduction, external rotation, extension). He/She will also assess to determine how the joint feels at the end range of motion to arrive at a diagnosis of frozen shoulder (loss of motion is noted in both passive and active ranges).
Pain medications prescribed by your medical doctor are often required to assist in recovery. Rhythmic stabilization (post-isometric stretching), gentle shoulder joint mobilizations and ultrasound are used to improve ranges of motion and reduce pain. TENS muscle stimulation may assist in reducing pain but will fail to correct the condition. Gradually Active Release Techniques may be incorporated to break down scar tissue and improve ranges of motion.
You MUST realize that this condition is very difficult to treat and will require significant dedication on your part to resolve. Very slow to resolve. With treatment most cases improve considerably (90 % or better) within one year. Without treatment most cases (60 %) do improve but over a much longer period (two years) and to a much lower degree. Failure to significantly improve may require referral for manipulation under anesthesia.
This is a very slow and laborious process that will take many months to resolve. Compliance and managing frustration due to pain and lack of rapid results will be your greatest challenges.
Avoid: Any activity that causes pain. Avoiding further Irritation/inflammation is very important.
Stage I (severe pain)
Typical duration is 1-3 months
This stage is primarily therapeutic and there is a limited amount that a patient is going to be able to do without assistance due to pain.
Exercises: Pendulum arm swings
Home Care: sleep on unaffected side with pillow under affected arm to provide support.
Stage II (reduced pain but worsening loss of motion)
Typical duration is 3 months
Exercises:
- Pendulum arm swings
- Post isometric relaxation stretches
- Rhythmic stabilization stretching (This form of stretching is not commonly used so we have included an explanation. Gradually move arm to end range of motion with minimal pain, patient contracts into a further stretch with <25% effort and holds for 6-7 seconds, patient relaxes and immediately switches the contraction into the opposite direction while the assistant gently resists. Then a new end range is found and the process is repeated multiple times.)
Home care: Wall walking (fingertips walk up the wall within limits of pain) Ball on the wall (try to hold your shoulder blade fixed while pressing a ball against the wall and make small concentric circles).
Rule for progression to Stage III: Less pain and significant improvement of range of motion in abduction and external rotation.
Stage III (gradual return of motion):
Gradual return to normal upper body workout. Home stretches are very important.
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