Frozen Shoulder

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This is when your shoulder stiffens, preventing full mobility. Its medical name is adhesive capsulitis and it is sometimes known as contracted shoulder.

Your shoulder is essentially a joint, known as a ball and socket joint.  In terms of the way it works, your humerus, which is the ball at the top of your upper arm bone moves according to which direction you choose in the socket located on the edge of your shoulder blade, your scapula.

These bones are for fluidity of movement and protection are covered in cartilage and fluid.  The whole joint in turn is encased in a loose fibrous capsule.  It is when this capsule shrinks, becoming scarred and tighter than it should be that problems begin to occur.

It can begin as a dull aching pain in one shoulder that progressively worsens with movement and it may be more keenly felt at night. Stiffness then sets in, preventing you from operating normally with simple day to day tasks such as even dressing yourself.

Frozen shoulder can cause a great deal of pain in your shoulder joint. It can affect just one or both shoulders and goes through several stages; the freezing, frozen and thawing phases.

During the freezing stage, frozen shoulder can be difficult to diagnose as it can begin as a dull ache and potentially develop into constant pain. This pain can extend from your shoulder to the muscles that wrap around your arm too.

Then, the stiffness stage begins. The pain can lessen in this phase, however, moving your shoulder can be extremely difficult.

The thawing phase begins when the stiffness gradually alleviates, the pain can return, however, afterward your shoulder returns back to normal.

Causes of a Frozen Shoulder

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It is believed that frozen shoulder happens when scar tissue forms in the shoulder. The shoulder joint’s capsule thickens and tightens, disabling full movement.  This can cause pain and stiffness to the shoulder joint.  Any injury could trigger frozen shoulder, rotary cuff injury, tendinitis and bursitis being amongst a few.  Medical procedures such as recovering from a stroke or mastectomy could also contribute.

 

Who can get a Frozen Shoulder?

 

It is more common in women than men, however it affects both sexes mostly around the ages of between 40 and 60 years.  Roughly it affects around 3% of people.  Those suffering from parkinsons, heart disease and thyroid disease also have links to getting frozen shoulder.

 

How does it affect you? – How serious is it?

 

In the first freezing stage, you are limited to how far you can move your shoulder. Most likely, this will cause you pain when you do so and gradually this worsens over time. Also, you may find it increasingly difficult to sleep at night due to it. This, on average, can last up to 9 months.

Next, you move into the frozen stage, where your pain can potentially improve, however, stiffness now sets in. Daily activities, such as driving and dressing become difficult as movement in your shoulder is limited. This stage can last anything between 4-6 months.

The last stage, the thawing phase, is the longest stage lasting anywhere up to two years.  Day to day this can greatly affect your ability to do things as you previously did and you may find yourself having to discover alternative methods to achieve the same thing.  In extreme cases you may find that you will not be able to drive.  On occasion surgery may even be recommended.

Recommended Treatment

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In the beginning stages you may want to take anti-inflammatory painkillers to manage the pain.  Try alternating between hot and cold packs on your shoulder to relax the muscle.  Keep trying to move your shoulder, being still will only add to the condition, gentle movement will speed your recovery.

When seated do not slouch, keep an upright position, gently keeping your shoulders back.  Do not lift heavy items, do anything that jerks your shoulder or do any strenuous gym exercises as this could potentially strain and worsen the condition of the shoulder.  A cushion under your arm, when seated, can also help stop you leaning forward and putting pressure on your arm affecting your shoulder.

Additionally, it may be helpful to wear looser fitting clothing so you can ease your arm into larger sleeves to avoid causing additional pain.

You may want to visit your doctor if your condition worsens. They will usually ask you to move your shoulder, then try moving it themselves without your assistance to ascertain the severity.  In addition, your doctor may suggest an anaesthetic injection in your shoulder to gauge your range of motion.  If you feel you would like something more conclusive, the diagnosis can be confirmed by a arthrography x-ray which is a dye test procedure.  This is where you are injected with a contrast dye and x-ray is taken of your frozen shoulder.  Your doctor will be looking for a shrunken shoulder capsule in your affected shoulder.

To help you achieve maximum benefit from physiotherapy your doctor may suggest you try a steroid joint injection to lessen the pain when moving your shoulder to receive treatment.

Recommended Rehabilitation and Supporting Equipment

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Movement to stop the shoulder from further stiffening is highly recommended.  Gentle movement to improve the shoulders range will be of great help.  Visiting a physiotherapist to thoroughly assess the stage of your frozen shoulder and therefore what physical therapy to receive is often crucial for recovery.  Your physiotherapist should give you exercises you can continue at home in between sessions and assessments.  In sessions your physiotherapist will manipulate your shoulder to aid in its mobilisation helping towards restoring normal movement.

You may find these exercises and stretches helpful.  Never stretch to the point of pain.  Even though you may have to do these exercises for months perseverance and repeated movement will pay off and result in an overall speedier recovery.  Warm up your shoulder beforehand to avoid pain and unnecessary stress on it.  If you have time a warm shower or bath is the perfect way to relax your muscles, relieving tension or you can use a heating pad held in the area for ten minutes to relax the muscles beforehand.

 

Pendulum Stretch

 

Find a table that is approximately waist height, stand next to it, lean over it placing your good arm on the table letting the affected arm hang limply by your side.

Relax your shoulders. Then, clockwise, swing your arm so it makes small circles, roughly a foot in size, after completing ten slowly stand upright. Again, relax your shoulders bend down once more and complete ten circles in the opposite direction. This will loosen up the shoulder muscles gently to prepare you for further exercises.

If you feel comfortable to enhance that stretch, hold a light weight in the swinging arm. Start with 1-2kg, going up to 5kg. Remember to stop if you feel any discomfort.

 

Lying Down Arm Lift

 

Lay down on your back on a yoga mat or something comfortable to support you.  Keep your legs straight out on the mat in front of you.  Keep your head still and eyes looking at the ceiling.

Gently use your unaffected arm to reach over to the affected arm’s elbow. Cup it beneath the elbow and slowly raise your affected arm up and over your head. Use your unaffected arm to support and hold for 15 seconds before gently bringing your arm down again.

Repeat this ten times or as many times up to this number that you feel comfortable. You should experience a stretch, but if there is any pain, stop.

 

Seated Arm Lift

 

Position a comfortable chair that does not move (has no wheels on it) next to a table that is preferably waist height. Take a seat next to the table, placing your affected arm flat palm down onto the table.

Gently lean forward, bending down towards your lap until you feel a stretch in your arm that’s on the table. Sit back up again and repeat at your own pace 10 times.

 

Finger Walk

 

This is simple but very effective and puts minimum strain on your shoulder whilst helping with mobilisation.

Find a plain wall with no objects on it and stand three quarters of an arm’s length away from it. Reach forwards with your affected arm from hip height touching the wall with your fingertips.

Relax your shoulders then proceed to walk those fingers up the wall. If at any point you feel you cannot proceed with that arm alone, you can help to gently support your affected arm with your good arm. If, however, this causes too much discomfort slowly lower your arm down and stop.  If possible try to repeat this exercise throughout the day roughly 10-20 times.

 

Cross Body Reach

 

You can choose to sit or stand, whichever makes you feel more comfortable.  Then with your good arm reach out to your affected arm’s elbow and gently bring it up and across your chest.  Hold this position applying pressure for a gentle stretch to the shoulder.  Do this 20 times a day or as much towards this number as you are able.

 

Outward Rotation

 

Relax your shoulders, then whilst standing place both arms at a ninety degree angle by your sides, holding an rubber exercise band between your hands.  Keep your good arm still and with your affected arm rotate outwards about three inches and hold for five seconds, repeat up to 15 times or as many up to this number as you feel capable of performing.

 

Inward Rotation

 

The easiest way to do this exercise is to stand side on next to a closed door.  Using your exercise rubber band, once again, loop one end of the band securely over the handle or knob of your door.

In your hand grasp the other end with your affected arm. Hold your elbow at a ninety degree angle and then pull the exercise band towards your body about three inches in distance, hold this for five seconds. Repeat up to 15 times or as many up to this number as you feel capable of executing.

 

Towel Stretch

 

Grab yourself a small towel, something around three foot in length. Stand, and put your affected arm behind your back holding one end of the towel. Then, with your good arm, hold the other end.

Use your good arm to mobilise and pull your affected arm upward to give it a good stretch. Do this up to 20 times or as many repetitions as you feel able. If you want to further advance this stretch place the towel over your good shoulder, behind your back with your affected arm take hold of the bottom of the towel and with your good arm hold the top part of the towel that’s on your shoulder. Use your good arm to pull the affected arm towards your back and upwards, only go as far as feels like a good stretch without causing pain. Do this for up to 20 times a day or as much as you feel able.

 

Armpit Stretch

 

Find a high chest height flat surface that you can place your outstretched arm on.  Stand facing it and use your good arm to place your affected arm flat on the surface palm down.

When in place, gently bend your knees until you feel a slight stretch in your armpit area. This will help to open up the armpit area loosening any tightness to further aid your shoulders mobility. Once you’ve felt the stretch, straighten and then bend again.

With each additional bend, deepen your knee bend so you are opening up your armpit area more and more.  Do this up to twenty times a day.  Stop if you feel too much discomfort.

Alternative & Homeopathic Treatments

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Pulsed Radio Frequency Treatment (PRF)

 

This method uses a high frequency current for lesioning the suprascapular nerve that is causing significant pain with the use of ultrasound guidance. On occasion, this can cause the pain to flare up for a short duration of a week, but overall it should effectively relieve you of most of your pain.

 

Cryotherapy Treatment

 

This is a treatment where your therapist will use a system that produces localized freezing temperatures to use on an irritated nerve to deaden it and reduce, if not relieve all pain.

 

Surgery

 

On occasion a frozen shoulder may have developed scar tissue that will need to be released.  Your doctor may refer you to a specialist bone and joints doctor at this point. This would be an orthopaedic who may wish to confirm your frozen shoulder with a variety of tests before proceeding.

They may consider two options: shoulder manipulation to loosen up scar tissue that has accumulated; performed under general anaesthesia, so you’ll be asleep during the procedure. The second considered option, also done under general anaesthesia, is arthroscopy. This uses keyhole surgery to take a look inside and cut any tight scar tissue sections surrounding your arthroscopic capsule.  Steroid injections for pain relief often follow after either of these has been done.

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