The shoulder is one of the most complex joints in the human body. This ball-and-socket type of joint is composed of the upper arm bone (humeral head), shoulder blade (scapula) and collarbone (clavicle). Muscles, tendons and ligaments surround the shoulder joint. It can move freely with the help of a synovial fluid that lubricates the joint capsule.
WHAT IS FROZEN SHOULDER?
Frozen Shoulder (also known as Adhesive Capsulitis) is a condition that affects the shoulder capsule (glenohumeral joint) with an idiopathic cause. It is characterized by severe pain and stiffness of the shoulder. The shoulder capsule thickens due to lack of synovial fluid that leads to tightness and stiffness. Frozen shoulder occurs between the ages of 40-60 years old and affects women than men.
Frozen Shoulder has three stages:
- Freezing (Painful stage) – last from six weeks to nine months, patient has a slow onset of pain (usually pain at rest), the shoulder starts to experience limitation of motion
- Frozen (Adhesive stage) – last from four to six months, pain begin to diminish (experiences pain upon movement), the shoulder gets stiffer, activities of daily living is affected
- Thawing (Recovery stage) – last six months to two years, shoulder’s normal range of motion is slowly returning to normal
Until now, the cause of Frozen Shoulder is still unknown. Physicians may ask you to undergo procedures like X-ray of the shoulder but it will only show normal results. So how will we know if it’s Frozen Shoulder?
The hallmark sign of Frozen Shoulder is unable to move your shoulder by yourself or with the help of other people. Diabetes Mellitus, stroke, trauma and immobilization are some of the identified risk factors for having Frozen Shoulder.
WHAT ARE THE SYMPTOMS?
A patient with Frozen Shoulder experiences a constant dull, aching pain (worse at night) aggravated by shoulder motions and cold weather. Limitation of motion is also seen wherein both active and passive movements are severely inhibited. The motion that is severely limited is the external rotation of the shoulder followed by abduction and internal rotation, respectively. It may also affect one or both shoulders simultaneously.
HOW CAN PHYSIOTHERAPY HELP?
Though Frozen Shoulder is a self-limiting condition, physiotherapy will help patients speed up their recovery. Managements include medications such as NSAIDS and corticosteroids, physiotherapy, occupational therapy, manipulation and/or surgery. The main goal of physiotherapy is to restore joint movement followed by pain reduction. Physiotherapy managements done by the physiotherapist include application of hot compress to loosen up the joint prior to movement, exercises such as stretching, peripheral joint mobilization, range of motion to improve shoulder’s motion and resistance exercise to maintain and strengthen the shoulder’s musculature. Home programs are also prescribed to patients so they can continue their exercises at home. Near normal to normal range of motion can be achieved through physiotherapy. The length of recovery time varies to every patient. If you’re working hard to regain your normal shoulder function, then you’ll be rewarded for a faster recovery.
Therapeutic Exercise by Carolyn Kisner, 4th Ed