Frozen Shoulder

What is frozen shoulder?
Frozen shoulder, or Adhesive Capsulitis, is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.

Typical symptoms of a frozen shoulder

• Shoulder pain
• Limited movement of the shoulder
• Difficulty with activities such as brushing hair, putting on shirts/bras
• Pain when trying to sleep on the affected shoulder

The stages of a frozen shoulder

Painful freezing stage
This is the most painful stage of a frozen shoulder. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts 6-12 weeks.

Frozen stage
During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last 4-6 months.

Thawing stage
The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

What causes frozen shoulder?
Most often, frozen shoulder occurs with no associated injury or discernible cause. There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:

Age and gender
Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women as in men.

Endocrine disorders
Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.

Shoulder trauma or surgery
Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest.

Other systemic conditions
Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.

Treatment
Frozen shoulder treatment primarily consists of pain relief and physical therapy. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer. Stretching exercises for frozen shoulder serves two functions: first, to increase the motion in the joint, and, second, to minimize the loss of muscle on the affected arm.

Exercise
Here are some exercise and stretching tips:

• Try a very warm shower, or even better a very warm bath just prior to beginning your exercise. The moist heat will increase local blood flow and stretchiness of the tissues in and around the shoulder joint.
• Start with good posture before beginning each exercise. If you look in the mirror and your natural relaxed posture reveals rounded shoulders and upper back and your chin is protruding forward, this will lessen the amount of motion you will be able to obtain. Retract your chin slightly, sit up tall or stand tall, and roll your shoulders backwards before beginning any range of motion exercise. By doing this you place your affected shoulder in a more natural position and will make the frozen shoulder exercise more effective.

• Increase your frequency and intensity of each exercise session. You should be stretching and strengthening several times a day, but each session should be briefer with focused intensity rather than 2-3 long drawn out sessions. You will see quicker results by not allowing the shoulder to stiffen up between sessions that are too far apart.

Anti-inflammatory medications
Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms.

Cortisone injections
Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. It is unclear the extent of the benefit of a cortisone injection, but it can help to decrease pain, and in turn allow for more stretching and physical therapy. What is known, about the cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.