Nature of the Frozen Shoulder, Causes and Treatment

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Dr Majid Kirmani

In the frozen shoulder, the shoulder capsule becomes stiff and tight. Adhesions develop in the tissues surrounding the shoulder joint. Shoulder movements become painful and restricted. In many cases the synovial fluid (lubricating fluid) in the joint decreases or becomes dry. Frozen shoulder pain can refer them to the upper arm and all muscles around the shoulder.
Frozen Shoulder has three stages:
Freezing Stage;
Frozen Stage;
Thawing Stage .
Freezing Stage:
In this stage, the patient develops pain and stiffness in the shoulder. As the pain worsens it results in decreased shoulder movements. Freezing stage lasts from 3 to 6 weeks till 6 to 9 months.
Frozen Stage:
In this set, age, pain may decrease but movements are very difficult and stiff. In these 6-9 months daily life activities have badly affected the patient cannot wear clothes properly or comb his hair or take him back to the upper back;
Thawing Stage:
Shoulder movements slowly improve during the thawing stage. It takes one to two years for complete recovery of motion and strength of shoulder. Improvement varies from patient to patient depending upon severity and treatment protocols.
Causes:
Diabetic patients are more prone to frozen shoulder but the reason behind it is unclear. Both men and women are affected though women are affected more. Frozen shoulder in diabetics takes more time to resolve.
Stroke patients can also develop frozen shoulder and some injuries to the shoulder joint can also result in the frozen Shoulder.
Rest or immobilisation after fracture or trauma to upper limb (arm) or any kind of surgery can also cause frozen shoulder.
Diagnosis:
Clinical evaluation and assessments did by a Physiotherapist/ Orthopaedic surgeon. Shoulder movements are checked in different directions. Blood tests or X- rays are not usually required unless there is some underlying cause/ pathology/disease. In suspected Rotator Cuff injuries , an MRI is advised.
Treatment:-
1. Physiotherapy plays a great role in treating frozen shoulder;
2. Frozen Shoulder usually responds to conservative treatment;
3. NSAIDs are advised to control pain;
4. Sometimes Intra-articular steroid injections are given to subside to inflammation, pain and stiffness the in the shoulder;
5. Some patients need Manipulation under anaesthesia (MUA) performed by an orthopaedic surgeon. The shoulder joint is gently moved while the patient is in general anaesthesia.
PHYSIOTHERAPY:
A physiotherapist uses different exercises, techniques and modalities for treating frozen shoulder.
1. TENS/IF help a lot in relieving pain;
2. Ultrasound Therapy also reduces adhesions and reduces local inflammation;
3. Manual therapy helps in mobilising the shoulder joint and increasing the range of motion;
4. Stretching and strengthening of shoulder muscles are done in later stages;
5. Shoulder Wheel Exercises, overhead pulley and Pendular Exercise, sex, are taught to the patient;
6. Some Home Exercise Plan is given to patient which include some simple wall exercises;
7. Resistance bands available in different brand names like Theraband or Active band can be used for stretching and strengthening the shoulder muscles patient should do 10 to 15 reps in 3 times a day. These bands are available in different colour codes/resistances. Your physiotherapist can advise you the proper band depending on our condition. The patient should avoid sleeping on the affected side and should avoid lifting heavy weights as this could further aggravate the pain patient should keep his arm moving in all directions. The patient should not rely much on medicines for recovery. These medicines can cause gastric (stomach) upset and other side effects. It is better to avoid pain killers and steroids. Instead, follow exercises as advised by a physiotherapist.

—The author is a Physiotherapist at District Hospital, Baramulla. He can be reached at: majidkirmani@gmail.com

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