Frozen shoulder

Frozen shoulder and Physical therapy

www.health.harvard.edu– The above pictures is from this website.

A few keys to determining if you have frozen shoulder are….

  1. Stiffness is your limiting factor of movement !!! Pain will also be a factor but stiffness is the leading limiting factor of movement
  2. The most limited movements will be usually in this order..external rotation (hand behind neck and elbow out)… then abduction (arm out to the side and up)…. then internal rotation (hand behind the back)
  3. It is more common in those that have diabetes and in women

According to the British Journal of Medicine…

It is more common if you have Diabetes, Dupuytren’s disease, fibromatosis, hyperthyroidism,hypothyroidism, hypoadrenalism, Parkinson’s disease, cardiac disease, pulmonary disease, and stroke.

Three phases of clinical presentation

Painful freezing phase Duration 10-36 weeks. Pain and stiffness around the shoulder with no history of injury. A nagging constant pain is worse at night, with little response to non-steroidal anti-inflammatory drugs

Adhesive phase Occurs at 4-12 months. The pain gradually subsides but stiffness remains. Pain is apparent only at the extremes of movement. Gross reduction of glenohumeral movements, with near total obliteration of external rotation

Resolution phase Takes 12-42 months. Follows the adhesive phase with spontaneous improvement in the range of movement. Mean duration from onset of frozen shoulder to the greatest resolution is over 30 months

Summary points

The three hallmarks of frozen shoulder are …shoulder stiffness; severe pain, even at night; and near complete loss of passive and active external rotation of the shoulder Lab tests are normal Frozen shoulder is rare under the age of 40; the peak age is 56 ,  Steroid injection is effective and best combined with physiotherapy. Refractory cases can be referred for manipulation under anaesthesia and, rarely, arthroscopic release

BMJ. 2005 Dec 17; 331(7530): 1453–1456.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1315655/

There are 5 major exercises/concepts that may help at home.

  1. Heat your shoulder if ok per Dr 20 minutes if no contraindications- no issues with heating. Be careful not to get your skin burned!!! The heat helps the tissue extensibility.
  2. Pulleys that can be purchased for about 15 to 20 dollars at any medical supply store

www.shoulderdoc.co.uk

Perform with good arm helping hurt arm raise up 20 x , 3 sets, 6 days a week for 8 weeks.

3. gynaeonline.com Wall slides with arm

Slide the arm up the wall 20 x , 2 sets, 6 days a week , 6 -8 weeks

4. thelondonshoulderpartnership.co.uk Codmans exercises

Let your arm dangle like a pendulum and let it rotate around like a circle 30 x , 2 sets , 6 x a week , 8 weeks

5. www.agedefyinggolf.com External rotation exercise

Sit up straight with elbow on table , lean body forward so that arm is going into external rotation, go slowly as best you can, it will hurt. Perform 10 x holding 10 seconds, 2 sets, 5 x a week, 8 weeks.

 

 

 

 

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16 thoughts on “Frozen shoulder

      1. I just changed my theme for the first time and set everything up new last Sunday. It is not difficult. But I had time to check it all out for more than two years already. So, just keep up exploring 😉

        Liked by 1 person

  1. Hi, is bursitis of the shoulder different from frozen shoulder? I have pain when I reach back but x-rays were negative so the doc said I had bursitis. I am following the old advice”If it hurts don’t do it,”and resting my shoulder. This seems to be helping more than ice or exercise so far. Any advice??

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    1. This is an excellent question. The distinguishing factor between bursitis and frozen shoulder is that with frozen shoulder stiffness is the limiting factor. It is usually most stiff into external rotation (moving your hand behind your neck with the elbow moving outward too). It is more common with diabetes. It will feel much better to use heat on this shoulder condition. Bursitis and rotator cuff small tears/rotator cuff tendonitis can have a lot of overlap. REaching behind the back maximally exposes what is called the supraspinatus muscle – the rotator cuff that helps lift the arm up to the side. The tricky part is that with frozen shoulder – reaching behind the back causes extreme pain and is very limited movement with frozen shoulder. Bursitis is inflammation of a bursa sack of fluid under the subacromial area. It will usually cause pain with trying to reach overhead from about 40 degrees to 120 degrees by way of pinching in the subacromial area. It is called impingement and the bursa sac gets pinched and inflammed. The best thing seems to be rest and not moving in any way that hurts. Using nsaids /anti inflammatories if the Doctor says it is ok to do can be helpful. After the pain and inflammation are down- usually about 1 and 1/2 weeks… middle trapezius rows with a therband help the bursa sac and impinged . I have some pictures of the middle trapezius exercise on the rotator cuff section. It sounds like it is subacromial bursitis. I need to do a section on that- hope this helps. Please feel free to ask me any questions anytime.

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      1. You are so knowledgeable! Thanks so much. The limitations on movement are only from pain so I think you’re right about the impingement. It has gotten better with rest and avoidance of painful positions. I doubt I’ll ever be able to swim the breast stroke though. Lol. This has gone on for several months after a Decadron pack. I am learning to live with it and be careful.

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  2. I’ve had a frozen shoulder twice. I don’t remember if it was one shoulder then the other or the same shoulder both times. The first time it occurred I was 46 years old, the second time I was around 52. I didn’t have any of the conditions you listed that put one at risk except being a woman. My first physical therapist really cranked on the shoulder to break the adhesions. My second physical therapist took a much gentler approach – recovery took longer but was a lot less painful. How likely is it that I’ll have another bout?

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    1. If it is not too personal to ask, do you have any medical conditions? I can give you a better answer if I know if you have any medical conditions, also your work, hobbies… do you do a lot of overhead activities? Do you paint overhead a lot, clean a lot overhead, reach and push activities a lot? Wipe windows, lift heavy things, sleep on your shoulder?

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      1. No medical conditions, no overhead work. I used to lift weights when I was in college, and off and on in the yers since then, but it had been awhile when I had the first freeze. Came on very suddenly, very painful, no range of motion, very hard to get comfortable to sleep. Would hate to go through it again.

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