What is Frozen Shoulder?

Frozen shoulder, formally known as adhesive capsulitis, is the sudden stiffening of the shoulder’s soft tissue capsule due to inflammation and fibrosis. Frozen shoulder has four clinical stages, each of which is characterized by specific clinical and pathological “milestones.”

There are two types of frozen shoulder: primary and secondary. The development of primary frozen shoulder is idiopathic, meaning it cannot be traced to a specific cause. Secondary frozen shoulder may develop due to predisposing factors such as injury or surgery in the shoulder region, systemic or metabolic diseases, or pathologies that indirectly affect the musculoskeletal system. Women are almost three times more likely to acquire the disorder than men!

Stages


1) Pre-freezing stage

Lasts up to three months

Characterized by acute pain and limited shoulder range of motion when raising arms forward, to the side, and behind the head and back.

2) Freezing stage

Lasts between three to nine months

Characterized by chronic pain and significantly more limited shoulder range of motion when raising arms forward, to side, and behind the head and back.

3) Frozen stage

Lasts between nine to fifteen months

Characterized by pain mostly present at end range of motion, significant limitation and rigidity in arm movements

4) Thawing stage

Lasts between fifteen to twenty-four months

Characterized by minimal pain, progressive improvement in shoulder range of motion

Risk Factors


  • Metabolic and hormonal disorders such as diabetes, hypothyroidism, hyperthyroidism
  • Neurological pathologies such as stroke, Parkinson’s disease
  • Shoulder injuries
  • Dupuytren disease
  • Complex regional pain syndrome
  • Tuberculosis
  • Metastatic cancer
  • Rheumatological diseases such as arthritis

How to Manage Frozen Shoulder?

You may have been told by your doctor or physical therapist that this disorder has a natural course, there’s no curing it, it’ll stick around for as long as it will. This is true, but it’s not an excuse to throw your hands up. Mostly, because you can’t. But also, if you’re already in for the ride, why not make it as painless and manageable as possible? Instead of passively letting it run its course, there are a few ways frozen shoulder can be treated (albeit not cured).

Exercises

An at-home exercise regimen should be followed in conjunction with physical therapy treatment. Depending on the stage, routines should include stretching—more appropriate for the acute stages—and muscle strengthening—better suited for the thawing phase where irritability is lower and muscle control must be reacquired after a long period of relative disuse.

Stretching the joint capsule, with time, will reduce tension on supporting tissues, thereby improving arm mobility and reducing pain. In the early stages, assisted active exercises with a rod (broomsticks and towels work just fine) are recommended. These drills don’t activate muscles around the affected shoulder, which may aggravate pain. Instead, they passively (with the help of the unaffected hand) push the frozen arm through a range of motion, thus stretching the capsule and eventually reducing joint rigidity. Other equipment with similar purposes, like pulleys, can be acquired online and easily installed on a door, for comfortable at-home use.

The following are some examples of exercises for managing frozen shoulder that can be performed at home:


 

Pulley 

As the condition progresses, a greater emphasis is placed on stretching with load, such as training with a resistance band in all planes of arm movement.

Resistance Bands

Conservative Treatments


Speak with your physical therapist about incorporating other modalities into your home treatment routine. Heating and electrical stimulation may be viable options for managing pain between clinic visits. It is recommended that these treatments are used in tandem with an exercise program and physical therapy. Most research shows that these tools are ineffective if used independently.

Transcutaneous Electric Neuromuscular Stimulation Device

In conclusion, frozen shoulder may appear seemingly randomly and resolve itself in its own time, but meanwhile, there are options for dealing with pain and managing limitations. Don’t let your stubborn shoulder pain freeze you out of participating in activities of daily living.