Frozen shoulder is a disorder in which in the shoulder becomes stuck in position. It is also referred to as adhesive capsulitis (stuck capsule). Research shows that frozen shoulder affects ~5% of the population in the US.
A normal joint capsule keeps the humeral head and the socket which is part of the scapula in the ideal position.
The joint capsule provides stability to the shoulder while allowing optimal movement.
When you have frozen shoulder, the capsule becomes inflamed. As the tissue damage progresses, scar tissue forms.
The capsule in turn becomes thick and tightens around the shoulder joint. Essentially, it sticks to the humeral head and restricts movement.
There is no known cause for frozen shoulder.
What we do know:
1. It is most common in women and persons between the ages of 40-60.
2. Most cases occur after prolonged immobilization due to prior injury.
For example, frozen shoulder may develop after a humeral fracture, rotator cuff tear, or prior surgery. This is usually referred as primary frozen shoulder.
3. Other risk factors include a history of diabetes, cardiovascular disease, thyroid disease, and autoimmune disorders. Frozen shoulder associated with systemic disease is categorized as secondary.
Symptoms of frozen shoulder include:
– pain during the day and night
– abnormal posturing of shoulder including hiking and muscle guarding.
– muscle spasms in the upper trapezius are common.
The 1st instinct when pain occurs is to avoid moving the affected arm, which leads to decrease movement.
As the symptoms progress, you lose the ability to raise your arm independently also known as active movement.
Eventually, you lose the ability to raise your arm with the help of the uninvolved arm, which is called passive movement.
Both your active and passive movement become limited. It will become difficult to reach to wash and style your hair, reach to dry your back, or reach an overhead shelf. Also, you will have trouble sleeping.
There are 3 stages each requiring specific treatment.
Therefore, it is important to know which stage you are in to receive the appropriate treatment.
Phase I – FREEZING: 6 wks- 9 months symptoms include:
INCREASED PAIN WITH MOVEMENT
Phase 2 – FROZEN: 4-6 months symptoms include:
FURTHER LOSS OF FUNCTION
INCREASED SCAR TISSUE
LIMITED EXTERNAL ROTATION (you may not be able to reach hair and put hair in a ponytail or reach to adjust shirt collar)
LIMITED ABDUCTION (you may have difficulty lifting arm to don deodorant)
PHASE 3: THAWING 6 months – 2 years
GOOD NEWS is if you have primary frozen shoulder, you will regain 90% of movement in the shoulder. However, if frozen shoulder is associated with diabetes, the outcome is poor.
SO HOW CAN OCCUPATIONAL AND HAND THERAPY HELP YOU?
Therapy will help to decrease your pain and inflammation, decrease scar tissue, and increase your movement.
Your therapist will help you to recover faster and regain your function to carry on with your usual daily activities.
In the 1st phase, the focus of treatment is on DECREASING PAIN AND INFLAMMATION.
TENs is a proven effective in managing pain and cold therapy for inflammation.
AVOID aggressive stretching:
Exercises in this phase are very gentle: scapula retraction, scapula depression, no money exercise, wand exercises, pendulum.
Phase II Increase circulation/ blood flow to help with healing. Ligaments take long to heal due to poor blood supply.
You may use a hot pack to increase circulation prior to exercises.
Exercises: gentle ROM exercises, ones from above, self ROM, ER on tabletop with cane, pass ball behind the back, isometrics (pain free)
Phase III Increase full ROM, more advanced stretches. Begin strengthening rotator cuff and scapula muscles. T band exercises. Exercises should be pain free.
Early intervention is the key to regaining your function faster.