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Frozen shoulder is a condition that affects the shoulder’s range of motion due to inflammation of the shoulder capsule. It has three phases and tends to occur more commonly in people over 40 and those with certain health conditions. Early diagnosis and physical therapy can help restore more range of motion. Treatment options include nonsteroidal anti-inflammatory drugs, heat and cold therapy, and transcutaneous electrical nerve stimulation. Maintaining movement and following a physiotherapist’s exercise program is key to recovery.
Adhesive capsulitis or frozen shoulder is a condition that affects the shoulder’s range of motion and for which doctors are unable to provide an exact explanation of why it occurs. The condition has three phases: an initial pain phase, in which the shoulder feels painful and the pain may inhibit the shoulder’s range of motion, the frozen phase in which movement of the shoulder may be very limited, and a thawing phase when some range of motion is restored to the affected shoulder. Frozen shoulder tends to occur more commonly in people over 40 and may be more common among people with autoimmune diseases, thyroid problems, heart disease, and diabetes.
What actually happens when you have a frozen shoulder is inflammation of the shoulder capsule, which is the connective tissue between the humerus (upper arm bone) and shoulder bone (scapula). Swelling can reduce the normal amount of fluid there is to lubricate the joints, which results in the joint being less able to move. Frozen shoulder usually affects only one shoulder, but it can significantly and sometimes permanently impair movement to the point that simple routine tasks, such as holding a fork to your mouth or brushing your hair, are nearly impossible.
The initial symptoms of the condition, during the painful phase, definitely prompt a visit to your doctor. Some doctors believe that an early diagnosis of frozen shoulder is beneficial because a regimen of physical therapy can begin right away. This can help restore more range of motion to the shoulder. Even when patients reach the thawing stage, not full range of motion will be restored to the affected joint, arm, and shoulder. Early intervention bodes well for better recovery from this condition.
If your doctor suspects a frozen shoulder, they’ll likely get the most information from a simple physical exam to check your range of motion. Your medical history will be taken, especially to check for any of the conditions mentioned above, and your doctor may also order x-rays or a magnetic resonance imaging (MRI) test to specifically evaluate for inflammation of the shoulder capsule. When the diagnosis is confirmed, doctors usually refer patients to physical therapists to immediately begin range-of-motion exercises that can help restore greater function to the shoulder joint.
To address the pain, doctors may consider prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium, or other NSAIDs available only by prescription. To treat immediate pain, some doctors inject steroids into the shoulder joint, but this treatment is not always recommended and especially should not be repeated often. Some steroids can actually cause more damage to the shoulder joint, particularly when used frequently. Doctors may also prescribe the alternating use of heat and cold to relieve inflammation. Some doctors recommend surgery to remove scar tissue from the shoulder joint.
Another possible treatment method for frozen shoulder is transcutaneous electrical nerve stimulation. This treatment basically delivers small bursts of electricity along the affected nerves via electrodes attached to the skin. This treatment is thought to stimulate the production of endorphins and relieve pain. It will not increase range of motion overall, but can be experienced when patients are significantly affected during the pain phase.
The key to frozen shoulder recovery is to continue to maintain as much movement as possible in the affected shoulder. Patients are advised to follow all the recommendations of a physiotherapist and to perform the proposed exercises and stretches on time. It is usually patients who do not seek treatment who end up with significant impairment of the shoulder joint. To avoid this, zealously follow the exercise program your doctor or physical therapist suggests and maintain, if pain or lack thereof permits, attempting to move your shoulder as much as possible. Even with rehabilitation therapy, some damage to the joint may remain, but with carefully guided exercise, you’re more likely to regain greater range of motion and regain use of your arm and shoulder.
