Frozen shoulder, also known as adhesive capsulitis, is a disorder that causes pain, stiffness and loss of normal range of motion in the shoulder. The resulting disability can be serious, and the condition tends to get worse with time if left untreated. It commonly affects people ages 40 to 60, with women being more affected than men.
While the cause of frozen shoulders remains unclear, we can say that an inflammatory process is likely involved. Sometimes, the “freezing” of the shoulder is the result of the shoulder being immobilized for a long time after an injury, surgery or illness. Fortunately, a frozen shoulder can still recover, though it may take some time — and lots of self-help.
A frozen shoulder usually occurs when the soft tissues become inflamed, typically due to injuries from overuse such as bursitis or tendinitis of the rotator cuff. Inflammation causes pain and becomes worse with movement. When the shoulder becomes immobilized, the connective tissue surrounding the glenohumeral joint — the joint capsule — thickens and contracts, losing its ability to stretch. Trying to avoid the pain caused by moving the shoulder leads to further contraction of the capsule. The humerus now has less space in which to move, and the joint may lose its lubricating synovial fluid. In severe cases, bands of scar tissue (adhesions) form between the joint capsule and the head of the humerus, hence limiting the shoulder’s range of motion.
A frozen shoulder may develop between two to nine months. Although the pain may slowly improve, the shoulder may remain stiff, and the range of motion remains limited.
Symptoms of frozen shoulder
According to The American Association of Orthopaedic Surgeons (AAOS), the symptoms of a frozen shoulder are classified in three stages:
The “freezing” stage
In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases and worsens at night. As time goes by, the shoulder becomes increasingly difficult to move. This stage lasts six weeks to nine months.
The “frozen” stage
When entering the “frozen” stage, the pain may seem to lessen, but the shoulder remains stiff. It is still very difficult to complete daily tasks and activities. This stage lasts two to six months.
The “thawing” (recovery) stage
In this stage, pain lessens, and the ability to move the shoulder slowly improves. A full or nearly full recovery occurs as normal strength and motion return. Pain may fade but occasionally recur. The stage lasts six months to two years.
Over 90 percent of people find that symptoms of frozen shoulder improve with simple exercises and pain control. A frozen shoulder normally recovers, but it can take three years.
How to diagnose a frozen shoulder
When diagnosing a frozen shoulder, you will need to consult with your doctor in order to discuss your symptoms and review your medical history. Your doctor will need to conduct a physical examination of your arms and shoulders. The doctor will try to move your shoulder in all directions to check the range of motion and if there is pain with the movement. During this exam, they check your “passive range of motion.” The doctor will also watch you move your shoulder to see your “active range of motion.” A person suffering from a frozen shoulder has limited range in both active and passive motion. X-rays of the shoulder will also be needed to make sure the cause of the symptoms is not due to other conditions such as arthritis. Advanced imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are usually not necessary to diagnose frozen shoulders. MRI and ultrasound results may be taken to look for other problems, such as a rotator cuff tear.
Treatment for frozen shoulder
The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder’s normal range of motion. Your doctor may recommend anti-inflammatory medication such as aspirin, ibuprofen or naproxen. An ice pack or bag of frozen vegetables applied to the shoulder for 10 to 15 minutes several times a day can also help with the pain. You may also be given a corticosteroid injection into the shoulder joint or soft tissues by a doctor.
However, the most reliable treatment for frozen shoulder is physical therapy that concentrates first on exercises that stretch the joint capsule and later strengthen them. A physical therapist can help with pushing yourself through appropriate exercises. Once you’ve learned your limitations, you can practice most of your exercises on your own at home.
While doing therapy, one should avoid any activities that require overhead reaching, lifting or anything that aggravates the pain. Following a strict regimen of shoulder exercises will likely restore one’s usual level of activity; more than 90 percent of patients improve with these nonsurgical measures. But full recovery from a frozen shoulder takes time — from several months to two or three years. If you don’t improve steadily or if you reach a plateau, go back to your doctor or consult a shoulder expert. Rare cases of frozen shoulder may require surgery.
How ice packs helps with shoulder mobility
In a recent study in the Journal of Strength and Conditioning Research, the use of ice was examined as a way to improve flexibility. According to the study, icing an injury causes a physiological reaction which alternates between two processes called vasoconstriction, or the constricting of the blood vessels, and vasodilation, or the widening of your blood vessels. Basically, the ice causes the veins in the affected tissue area to constrict. This reduces the flow of blood while acting as a kind of anesthetic to numb the pain. But when the ice is removed, the veins expand to allow a large volume of blood to rush to the affected area. The blood brings with it important chemicals that aid in the healing process.
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