Frozen shoulder recovery stories

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I Was Diagnosed with Frozen Shoulder: If You’re A Woman, You Could Be, Too

Julie Metz

By Julie Metz, Special to Everyday Health

I woke one morning in early December 2010 with a throbbing ache in my right shoulder. Unlike my other midlife sprains and pains, it got worse. I began marking time with doses of ibuprofen, noting—with alarm—how my stiff arm could barely reach the medicine cabinet. An orthopedist ordered an x-ray. “You might have a small tear in your rotator cuff,” he said and sent me home with a script for eight weeks of physical therapy.

The aggressive physical therapy sessions (conducted by a well-intentioned but, in retrospect, inexperienced therapist) were excruciating but I stuck with it. Without sleep I was breaking down. I started washing my ibuprofen down with red wine. When I tried to move my arm out of an increasingly narrow range of motion, it felt like someone was jabbing me with a kitchen knife. I was up to eight ibuprofens a day. My stomach was not amused.

After six weeks of this torture, an MRI (I had to plead) finally revealed a diagnosis unseen in the x-ray: Adhesive Capsulitis (AC), or “frozen shoulder,” a spontaneous inflammation of the capsule tissue surrounding the joint where the collarbone, scapula, and upper arm bone meet.

You’ve probably never heard of AC, unless you or someone you know has endured it. The medical community still doesn’t have a full understanding about what causes it. That’s not for lack of cases. Statistics vary from 2% to as high as 5% of the general population. It affects more women than men, as well as people with diabetes and thyroid conditions. And it can run in families. After my diagnosis, I remembered that my brother had had shoulder pain several years earlier, as had my mother before him. He sent me to his physiatrist where I finally found relief.

Vijay Vad, M.D. at the Hospital for Special Surgery in New York City explained that left untreated, the capsule becomes inflamed, then frozen and scarred, before finally “thawing” on its own. The process can last months, even years, before resolving as mysteriously as it begins.

As David M. Dines, MD, (an orthopedic shoulder surgeon at HSS) says, “Adhesive Capsulitis is an enigmatic and bad-ass disease.” I’ll admit that it was just a little cool that anything about my ordeal could be called bad-ass.

Julia Metz
Photo Credit: Piotr Redlinski/ The New York Times

Dr. Vad (pretty much the nicest doctor I’ve ever met), has a mantra when it comes to AC which I pass on to you: “If you have pain in your shoulder, and there was no specific injury, and the pain is getting worse, and you’re beginning to lose range of motion, you should get to a doctor immediately. If you feel you might have a frozen shoulder, don’t sit and wait—take charge. In my own practice, it’s a ratio of 4 to 1, women to men. The truth is that there just hasn’t been the funding for medical research. The Women’s Health Initiative has helped raise awareness around these important health issues affecting women after menopause. The whole idea of just sending a patient home to wait out years of suffering is just unacceptable. This condition should really be studied as a women’s issue.”

Frozen shoulder moves through four stages: inflammation, freezing, frozen, and thawing. Getting the disease resolved quickly depends on matching available treatments to your stage. In the early stages, sonogram-guided cortisone shots will often be enough. In the frozen period, when the tissue becomes rock hard and the shoulder is completely immobile, surgery is often recommended. I was in late Stage 2 and for this Dr. Vad proposed a capsule distension procedure. Unfortunately, you may have trouble finding a doctor who can perform this procedure for you. Capsule distention isn’t covered by many insurance plans and therefore many doctors don’t want to do it.

In this minimally invasive procedure, the physician, using a sonogram as a guide, injects saline solution into the joint capsule to expand and then flush or “lavage” it, and then injects cortisone and other pain relievers. I won’t lie—even with a sweet sedative this was no fun, but in 15 minutes it was over. Within days the pain backed off. I spent a full year in PT rehabilitating my shoulder. Dr. Michael Zazzali, my new physical therapist, has had many years of experience with shoulder issues and his approach was completely different. Recovery was slow but steady, without the intense pain of the first physical therapy sessions. I am delighted that I can now do cobra pose in yoga class, though my days of headstands and “broken in eight places” might be over. Two years later, when pain started in the other shoulder (yes, if you’ve had it on one side, you have a 50% chance of recurrence on the other side!), I went straight to Dr. Vad for a cortisone shot and that was the end of it.

I’ve become a bit of health nut since that first episode. Our kitchen is piled high in kale. I drink a pot of green tea a day. I take Omega oils and every morning my boyfriend makes a berry smoothie. I eat oatmeal and avoid bread pasta, and sugar. I eat lean meat and not that much. I still eat chocolate daily because without that life isn’t worth living. I feel better and stronger since I altered my diet.

“The things to avoid are fatty meats and processed sugar,” says Dr. Vad. “Absolutely the enemy because they really increase inflammation. The three supplements that can really help reduce inflammation for my patients are: Omega 3 (fish oil), Vitamin D, and the spice turmeric.”

While there is still no cure right now for AC, Dr. Vad and Dr. Dines both look to ongoing research into the use of collagenase, enzymes that break the peptide bonds in collagen, the main component of connective tissue. “I believe Collagenase injections will become the future treatment for frozen shoulder,” forecasts Dr. Vad.

Let’s hope so.

Julie Metz is the author of the New York Times bestselling memoir Perfection (Hyperion, 2009). It was a 2009 Barnes & Noble Discover Great New Writers Selection, has been translated into six languages, and was featured on “The Oprah Winfrey Show.” The recipient of a MacDowell fellowship, Julie has written for publications including The New York Times, Huffington Post, Publishers Weekly, Glamour, Coastal Living, Prevention, Family Circle, Redbook, and websites such as Wowowow.com (The Women on the Web), Family.com, and the story site mrbellersneighborhood.com. A recent essay titled “Instruction” was included in the anthology The Moment (HarperCollins, 2012), edited by the creators of Six Word Memoirs. You can find out more about her work at www.juliemetz.com

How to Melt a Frozen Shoulder (Adhesive Capsulitis)

by Michelle Sutton-Kerchner

Those who suffer a frozen shoulder know it’s not easily shrugged off. Often, it’s not easily moved at all. Combined with a gripping pain and radiating aches, this condition really gets you in its clutches. Here are tips when you’re ready for a meltdown …

Most never give a thought to their shoulders and all the mechanics involved for their daily functioning. Until one day, for seemingly no explanation at all, they demand attention.

Although lifting a heavy object can trigger low back pain and an overstuffed pillow can kink your neck, the shoulder seems to suddenly protest for no reason. And when it does, don’t even think about a simple act like waving hello or flagging a taxi. A frozen shoulder also makes a lousy bed-partner. Dare to shift your arm the “wrong” way during the night, and it can interrupt sleep for hours with its complaining.

Causes

A frozen shoulder, or adhesive capsulitis, occurs when motion of the shoulder joint becomes restricted. The capsule that surrounds this ball-and-socket joint becomes contracted. Bands of scar tissue, or adhesions, develop and the shoulder doesn’t seem to budge without forcing a wince.

When there is pain with movement, movement decreases. This increases stiffness and, eventually, shoulder movement may become completely impaired. Simultaneously, and not by coincidence, your ibuprofen stash may decrease as well. So much for the joint that usually allows more motion than any other in the body!

Occasionally, this condition is triggered by trauma to the shoulder. (You may consider lightening that 10-pound purse or desk-in-a-bag.) However, most often, there is not a clear cause, only risk factors indicative of predisposition.

Perimenopause: Although a medically defined connection has not been provided yet, frozen shoulder tends to occur between the ages of 40 and 60 years old. About 70 percent of those affected are women. These statistics suggest a correlation between frozen shoulder and a hormonal shift that occurs in the early or pre-stages of menopause.

Shoulder surgery or immobility: When an operation or injury requires joint immobilization, such as through an arm cast or healing process, the shoulder joint becomes susceptible to freezing.

Diabetes and thyroid imbalances: Endocrine issues can affect joints and muscles. Frozen shoulder is reported to occur in 10 to 29 percent of those with diabetes. Sugar adheres to the collagen in cells and affects their functioning. Also, diabetes can damage blood vessels. A poor blood supply may result in scarring of the body’s elastic tissues, which can trigger a frozen shoulder.

Symptoms & Diagnosis

Typically, extensive diagnostic testing is not needed to confirm frozen shoulder. Presentation of symptoms usually is a clear indicator. A physician may wish to eliminate the possibility of a rotator cuff injury through an x-ray, as these symptoms sometimes overlap. An x-ray also reveals arthritic changes or possible injury in the area.

An MRI is occasionally performed with an injection of contrasting fluid in the shoulder joint to help reveal if the shoulder capsule is scarred.

Typical presentation:

  • Dull, aching shoulder pain
  • Restricted movement and movement accompanied by pain
  • Disrupted sleep from stiff and sore shoulder area
  • Frustration performing everyday activities, such as shampooing, putting on shirts, putting on and wearing a bra, folding clothes, and keyboarding

Bring on the Thawing Stage

The frozen and most painful stages of this condition can last up to nine months. At that point, the worst symptoms have peaked, most likely along with your tolerance level. This thawing stage can be lengthy, lasting longer than a year. However, with early detection and proper treatment, severity and duration can be reduced.

Treatment

As with many injuries, frozen shoulder responds well to physical therapy treatment. Working with a physical therapist allows stretching of the joint in a controlled environment. According to Ruth Lyons, PT, MPT, getting the joint in motion is essential. It breaks up scar tissue that has formed and reduces stiffness from immobility. Combined with a prescribed exercise program, the frozen shoulder begins to melt and strength returns.

Be prepared. Exercising and stretching a joint that’s been dormant is a slow process that may be accompanied by irritation. The muscles and joint are coming back to life. It’s natural to experience some soreness in this no-pain/no-gain scenario. Start slowly, and gradually increase the swings and weight used in range-of-motion exercises.

Ruth recommends performing the following: circular pendulum, side-to-side pendulum, and horizontal abduction/adduction. As you progress, these exercises become more effective when using two-pound hand weights or wrist weights. Increase to three pounds, when ready.

With radiating pain, you may find the entire rib cage, arm, and hand are troublesome on the affected side. Flexion exercises with a wand (broom, cane, yardstick, or any other stick-like object at hand) provide a good stretch that helps all these areas.

Intervals of exercising and stretching throughout the day are essential. Team with a personal trainer for optimal therapeutic results.

A personal trainer can supplement your time spent in physical therapy. For success, these exercises must be performed three times a day at 20 sets each session, in addition to the techniques utilized in the physical therapy session. With the assistance of a personal trainer, you are assured proper form and maximum efficacy for a quicker recovery process. A trainer can also create a fitness program that incorporates your frozen shoulder to limit muscle atrophy. A bum shoulder shouldn’t derail your overall fitness goals. (For tips on exercising with an injury, see “Go the Extra Mile” at www.fitnessandwellnessnews.com/fitness/go-the-extra-mile.)

Go Hot & Cold

Prior to stretching and exercising, apply moist heat to the shoulder. This loosens and soothes the joint and surrounding muscles. Microwavable heating pads are available in a variety of sizes, some filled with aroma-therapeutic scents. They are an excellent household item, especially for the exerciser. If you don’t have a heating pad available, apply a washcloth soaked in hot water. Leave heat on for 10 minutes prior to beginning your program. When finished, apply an ice pack for the same. Ice will reduce any inflammation that flared during your efforts.

No Quick Fix

A shot of cortisone might sound appealing on days you’re ready to leave your arm behind. Some experience relief from this injection; others don’t notice any improvement. One certainty: To be effective, a cortisone injection should be used in combination with physical therapy and exercise. Its main purpose is to reduce pain for better mobility and stretching during treatment programs.

By adhering to a well-rounded therapy/exercise program– which includes intervals of stretching, exercise, and rest (along with any other modalities your physical therapist and personal trainer deem appropriate)– you can fully recover from a frozen shoulder. Arthroscopic surgery is a last result and rarely performed. Without immediate post-operative rehabilitation, your frozen shoulder could easily return. Best to avoid such last-resorts and work it out!

Sources

“Frozen Shoulder,” at www.mayoclinic.com.

“Frozen Shoulder and Diabetes,” by Gordon Cameron, MD at www.diabetesmonitor.com.

“Frozen Shoulder in Diabetes,” by Paul Schickling, RPh, CDE, and John Walsh, PA, CDE at www.diabetesnet.com.

“Frozen Shoulder Symptoms,” by Jonathan Cluett, MD at www.about.com.

“What Is a Frozen Shoulder?” by Jonathan Cluett, MD at www.about.com.

“What Is the Treatment of a Frozen Shoulder?” by Jonathan Cluett, MD at www.about.com.

Images

Bare shoulder: www.flickr.com/photos/blythe_d/1556876413/

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5 Things You Need to Know if You Have Frozen Shoulder

If you’ve heard about frozen shoulder—also known as adhesive capsulitis—you know it’s no fun. A frozen shoulder has lost its normal range of motion and causes pain. The condition can last for several months, and people living with it should know these 5 things:

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Frozen shoulder symptoms include shoulder pain, stiffness, and decreased range of motion.
See What to Know About Frozen Shoulder

1. You might get tendonitis
Frozen shoulder tends to pull the rounded head of the humerus (upper arm bone) further into its socket. People with frozen shoulder may notice that the affected arm appears just a tiny bit shorter than the other. The tendons in the arm can become stressed trying to compensate for this change, resulting in tendonitis or another tendinopathy. Avoiding painful movements, gentle stretching, and physical therapy can help relieve tendonitis symptoms.

See What Is the Difference Between Tendonitis, Tendinosis, and Tendinopathy?

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2. …And neck pain
Day-to-day movements, like washing hair, putting on jerseys, or sleeping in positions that don’t cause more shoulder pain, may strain the neck. Over time, the neck may become stiff or painful. Regular stretching and massage can help relieve neck tension.

See Frozen Shoulder Symptoms

3. You should use your affected arm
Resting the affected arm does not help the shoulder heal. In fact, medical professionals say that resting the shoulder may make the condition worse by allowing more adhesions to develop around the shoulder capsule. In addition, using the shoulder helps maintain muscle strength, which can prevent additional problems later on.

See Treating Frozen Shoulder

So, it may be a little uncomfortable to keep both hands on the steering wheel or reach up into the cupboard, but if you can do it without triggering pain, try it.

4. Hormones matter
Women in their 40s and 50s are at a higher risk to get frozen shoulder. Many women have reported cases of frozen shoulder that coincided with perimenopause, menopause or the start or end of hormone replacement therapy.

See Frozen Shoulder Causes and Risk Factors

5. The shoulder may not regain its full range of motion
Medical experts refer to frozen shoulder as a “self-limiting” condition, meaning it will eventually go away on its own. However, people with frozen shoulder may not regain their full range of motion. They may also notice that their affected shoulder still pops up a little higher than the other shoulder when they raise their arms over their head.

See Diagnosing Frozen Shoulder

After several months of shoulder pain and severely restricted movement, many people are simply glad to have an “almost normal” shoulder. But long-term affects are no doubt disappointing and frustrating. People who want to try to regain 100% range of motion can talk to their doctors or physical therapists to find out if additional therapies can help.

Learn more:

Rotator Cuff Injuries

SLAP Tear Shoulder Injury and Treatment

TUESDAY Q & A: “Frozen shoulder” develops slowly and can take months to heal

DEAR MAYO CLINIC: I’ve had pain in my right shoulder for a few weeks that has been getting worse rather than better, even though I’m letting it rest. I have read the term “frozen shoulder” – could that be what I have? What causes it? Should I see my doctor, or will it eventually heal on its own?

ANSWER: It is possible that you are experiencing a condition known as frozen shoulder (adhesive capsulitis). Although recovery can take several months to a year or more, a variety of treatments may help improve your shoulder joint’s range of motion. Make an appointment to see your doctor. He or she will be able to discuss your symptoms and help determine the cause.

Your shoulder joint is made up of bones, ligaments and tendons. Surrounding the joint is strong connective tissue called the shoulder capsule. Normally, the capsule and joint are lubricated by synovial fluid. Frozen shoulder occurs when the capsule thickens and tightens around the shoulder joint. Stiff tissue bands (adhesions) may develop, and there may be less synovial fluid in the joint. Usually, just one shoulder is affected.

It’s unclear what triggers the change. Women are affected more often than are men, and it’s also more likely to occur in adults 40 and older. A prolonged period of shoulder immobility or reduced mobility may increase your risk. Immobility may be related to various factors, such as rotator cuff injury, a broken arm, recovery from surgery or a stroke. Your risk may also be greater if you have certain medical problems. Frozen shoulder is five times more common in people who have diabetes. Other conditions that may increase risk include thyroid disease, cardiovascular disease and Parkinson’s disease.

Frozen shoulder usually develops slowly, progressing through three stages:

Painful stage — During this period, shoulder pain occurs with any movement and is usually worse at night. Pain is often significant whether your shoulder is at rest or in use, so the tendency is to use the arm less. The joint’s range of motion starts to become limited as your shoulder gradually stiffens.

Frozen stage — Pain may begin to diminish, particularly when the joint isn’t being used. Range of motion decreases noticeably as your shoulder becomes even stiffer. Daily living activities, such as combing your hair or putting on a belt, may become nearly impossible.

Thawing stage — Range of motion in your shoulder begins to improve, but often pain lingers.

A diagnosis of frozen shoulder can be distressing, especially given the length of time it may take for resolution of the pain and stiffness. Whether treated or not, the majority of frozen shoulders improve on their own over the course of 6 to 12 months, but sometimes it can be up to 18 months. Without treatment, return of motion generally is gradual, but normal, full-range motion may never return. Most people experience improvement from relatively simple treatments.

To help reduce pain and inflammation, your doctor may recommend nonprescription pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others). If needed, your doctor may prescribe stronger anti-inflammatory drugs. A corticosteroid injection into your shoulder joint during the first stage may be of particular benefit for pain relief, and some studies suggest that repeated injections in the early stages can help hasten recovery.

Most treatments involve moving and stretching the shoulder — just the opposite of what you might think to do when your shoulder begins to hurt and stiffen. Your doctor may recommend simple exercises that you can begin right away to help prevent further loss of shoulder function. A physical therapist may teach you stretching exercises to help you maintain and eventually regain as much mobility in your shoulder as possible. As the joint thaws, you may be given exercises to help strengthen your shoulder’s rotator cuff muscles and the muscles that stabilize your shoulder blade (scapula).

Some find transcutaneous electrical nerve stimulation (TENS) useful as an alternative approach to pain relief. TENS delivers small electrical impulses through electrodes placed on the shoulder.

If your symptoms remain persistent, your doctor may suggest other procedures. These could include injecting sterile water into the joint capsule to expand the tissue and make more room for joint movement, or arthroscopic surgery to remove scar tissue inside the joint. — Aaron Krych, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

How to release a frozen shoulder

Simple activities like fastening a bra or taking a book off an overhead shelf can be impossible when you have a frozen shoulder.

Updated: March 19, 2019Published: November, 2010

Frozen shoulder (also called adhesive capsulitis) is a common 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 it’s not treated. It affects mainly people ages 40 to 60 — women more often than men.

We don’t fully understand what causes a frozen shoulder, but an inflammatory process is probably involved. Sometimes freezing occurs because the shoulder has been immobilized for a long time by injury, surgery, or illness. In many cases the cause is obscure. Fortunately, the shoulder can usually be unfrozen, though full recovery takes time — and lots of self-help.

The shoulder has a wider and more varied range of motion than any other part of the body. It pivots mainly on a ball-and-socket arrangement called the glenohumeral joint, which joins the top of the humerus (upper arm bone) to a scooped-out part of the scapula (shoulder blade) called the glenoid cavity. (See the illustration, “Anatomy of a frozen shoulder.”)

The glenohumeral joint helps move the shoulder forward and backward and allows the arm to rotate and extend outward from the body. A flexible capsule filled with a lubricant called synovial fluid protects the joint and helps keep it moving smoothly. The capsule is surrounded by ligaments that connect bones to bones, tendons that fasten muscles to bones, and fluid-filled sacs called bursae that cushion tendons and bones during motion. The band of muscles and tendons that stabilizes the shoulder and controls its movements is called the rotator cuff. This elaborate architecture of soft tissues accounts for the shoulder’s marvelous flexibility, but also makes it vulnerable to trauma as well as chronic wear and tear.

Anatomy of a frozen shoulder

Normally, the head of the humerus moves smoothly in the glenoid cavity, a depression in the scapula. A shoulder is “frozen” when the capsule protecting the glenohumeral joint contracts and stiffens. Scar tissue (adhesions) may also form between the joint capsule and the head of the humerus.

How does a frozen shoulder happen?

The process usually begins with an injury (such as a fracture) or inflammation of the soft tissues, typically due to overuse injuries such as bursitis or tendinitis of the rotator cuff. Inflammation causes pain that is worse with movement and limits the shoulder’s range of motion.

When the shoulder becomes immobilized in this way, the connective tissue surrounding the glenohumeral joint — the joint capsule — thickens and contracts, losing its normal capacity to stretch. Trying to avoid the pain caused by moving the shoulder leads to further contraction of the capsule. The humerus has less space to move in, and the joint may lose its lubricating synovial fluid. In advanced cases, bands of scar tissue (adhesions) form between the joint capsule and the head of the humerus.

A frozen shoulder may take two to nine months to develop. Although the pain may slowly improve, stiffness continues, and range of motion remains limited.

Who gets frozen shoulder?

The frozen shoulder risk is increased when you don’t receive exercise therapy after tendinitis or an injury, and when you wear a sling for more than a few days without intermittent stretching. About 10% of people with rotator cuff disorders develop frozen shoulder. Enforced immobility resulting from a stroke, heart condition, or surgery may also result in a frozen shoulder. Other conditions that raise the risk of a frozen shoulder are thyroid disorders, Parkinson’s disease

What to do about a frozen shoulder

If you think you have a frozen shoulder or are developing one, see your clinician or a shoulder expert for a physical exam. To assess your shoulder’s range of motion, the clinician will ask you to perform various movements with your arm, such as reaching across your chest to touch the opposite shoulder or down your back to touch the opposite shoulder blade (the Apley scratch test). She or he may take x-rays to make sure there’s no other underlying problem, such as arthritic changes or a dislocation. An MRI may be ordered to check for a rotator cuff tear.

The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder’s normal range of motion. Your clinician may recommend an anti-inflammatory medication such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve, Anaprox). 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 pain. You may be given a corticosteroid injection into the shoulder joint or soft tissues. But the cornerstone of treatment is physical therapy, concentrating first on exercises that stretch the joint capsule, and later, on strengthening exercises. A physical therapist can show you how far to push yourself and can teach you the appropriate exercises. Once you’ve learned your limitations, you can practice most of your exercises on your own at home.

As you work to stretch the shoulder capsule, you should avoid any activities that require overhead reaching, lifting, or anything else that aggravates your pain. If you diligently follow your regimen of shoulder exercises, it’s likely that you’ll be able to resume your usual level of activity (more than 90% of people 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 clinician or consult a shoulder expert. Rarely, recalcitrant cases require surgery.

Stretching exercises for frozen shoulder

Always warm up your shoulder before performing your exercises. The best way to do that is to take a warm shower or bath for 10 to 15 minutes. You can also use a moist heating pad or damp towel heated in the microwave, but it may not be as effective.

In performing the following exercises, stretch to the point of tension but not pain.

Pendulum stretch. Perform this exercise first. Relax your shoulders. Stand and lean over slightly, allowing your affected arm to hang down. Swing the arm in a small circle — about a foot in diameter. Perform 10 revolutions in each direction, once a day. As your symptoms improve, increase the diameter of your swing, but never force it. When you’re ready for more, increase the stretch by holding a light weight (three to five pounds) in the swinging arm.

Towel stretch. Grasp a three-foot-long towel with both hands behind your back, and hold it in a horizontal position. Use your good arm to pull the affected arm upward to stretch it. You can also perform an advanced version of this exercise with the towel draped over your good shoulder. Grasp the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm. Do this 10 to 20 times a day.

Finger walk. Face a wall three-quarters of an arm’s length away. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until you’ve raised your arm to shoulder level, or as far as you comfortably can. Your fingers should be doing the work, not your shoulder muscles. Slowly lower the arm (with the help of the good arm, if necessary) and repeat. Perform this exercise 10 to 20 times a day.

Cross-body reach. Sit or stand. Use your good arm to lift your affected arm at the elbow, and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the stretch for 15 to 20 seconds. Do this 10 to 20 times per day.

Armpit stretch. Using your good arm, lift the affected arm onto a shelf about breast-high. Gently bend your knees, opening up the armpit. Deepen your knee bend slightly, gently stretching the armpit, and then straighten. With each knee bend, stretch a little further, but don’t force it. Do this 10 to 20 times each day.

Starting to strengthen

After your range of motion improves, you can add rotator cuff–strengthening exercises. Be sure to warm up your shoulder and do your stretching exercises before you perform strengthening exercises.

Outward rotation. Hold a rubber exercise band between your hands with your elbows at a 90-degree angle close to your sides. Rotate the lower part of the affected arm outward two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.

Inward rotation. Stand next to a closed door, and hook one end of a rubber exercise band around the doorknob. Grasp the other end with the hand of the affected arm, holding the elbow at a 90-degree angle. Pull the band toward your body two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.

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Cochrane UK’s Sarah Chapman blogs about evidence and experience in treating adhesive capsulitis, or ‘frozen shoulder’, with the help of another Sarah, a physiotherapist.

I have happy memories of races round my grandparents’ garden on the pair of crutches Grandpa used while his knee (the cap blown away on the Western Front) was healing. They were brilliant things, which I suspect he must have made or altered himself; wooden, with curved runners on the bottom, which allowed us to propel ourselves round at some speed! I rediscovered them a few years ago and had to have another go. I’ve always taken a grateful delight in having a body that does what I ask of it. Give me a supermarket trolley and a clear aisle, and I can’t resist scooting along with my feet off the ground, and every now and then I like to check that I can still stand on my head. On leaving the care home I’d been visiting recently, I sprinted across the courtyard, just for the joy of being able to do so.

But I’ve recently turned into a ‘bad arm in first’ kind of person and, horror of horrors, have caught myself uttering “oofs” and “ahs” when exerting myself. I’ve developed a cunning technique for pegging washing on the line, involving a sort of launch-and-slide manoeuvre. I now wash my hair one-handed and act my age in supermarkets. It turns out that the reason for all this is that I have adhesive capsulitis, or ‘frozen shoulder’. So, as an example of making everyday health choices, I thought I’d write about it.

Three important things

Ideally, health choices are made on the basis of three things: the best available evidence from research, the patient’s preferences and values, and clinical expertise.

The three elements of evidence-based practice

Unlike this tidy diagram, these elements won’t necessarily make an equal contribution and, as I’m all too aware, there may not be reliable evidence to inform a decision. Let’s see…

Health choices begin when the problem does

My first choice, on developing a sore arm, is to do nothing and hope it resolves. But actually, a decision has to be made even at this point; should I rest it or use it? I don’t think ‘sore arm’ will bear much fruit in Google or the Cochrane Library, so I don’t try the internet. Instead, I do that thing that forms part of our decision-making about health and much else: I ask other people what they think it might be, and listen to tales of other people’s sore arms and what it was and what they did. I drop out of my exercise class, although aware that this is not a good move for my general health and fitness, and otherwise carry on as near normally as possible. After all, it’s not that bad.

Fast forward a few weeks, I see a GP. He thinks it’s a rotator cuff problem and gives me a leaflet showing shoulder exercises for unspecified problems and suggests I take ibuprofen for a week. He mentions that, if it doesn’t improve, physiotherapy might help. I don’t feel very confident about the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of the exercises, but resolve to do them diligently. I don’t do them diligently… I do them sometimes, when I remember, and decide to give it a couple of weeks before seeing a physiotherapist. I’m reluctant to take the ibuprofen; I don’t want to be taking medication for weeks and I’m not so sore I feel I have to so, after a few doses, I don’t. I’m reminded of that terrible phrase given to patients (I’ve become a patient!) like me – ‘non-compliant’. Ugh!

Better see a physiotherapist

Three weeks on and I am more restricted in what I can do and, if I move my arm suddenly, the pain is enough to stop me in my tracks. I am fortunate in being able to take myself to a physiotherapist, also called Sarah. She is great. I am a bit horrified at just how limited my range of movement is shown to be. She tells me this isn’t a rotator cuff problem but adhesive capsulitis. The good news is that it will resolve by itself. The bad news, this is likely to take one to two years. YEARS! Is there anything I can do while I’m waiting, other than invent gadgets that will help me do stuff, like hang out the washing (where are you, Grandpa?)?

It seems there are a few things that may help increase my range of movement, at least a little, and reduce pain. Injected steroids, manipulation, and exercises. Before I’ve even looked at the evidence for each option, my preferences come into play. I reject the idea of steroids and resolve to embark on the exercises Sarah has shown me. I now need to do two things: get hold of a walking stick with which to perform the exercises and look for evidence about the benefits and harms of each interventionA treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. .

Treating frozen shoulder: what does the evidence say?

What’s the evidence on treating frozen shoulder?

I start with the Cochrane Library, hoping there are some relevant Cochrane ReviewsCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research., bringing together the best available primary research on treatments for frozen shoulder.

Evidence on manual therapy and exercise

There is a Cochrane review on manual therapy and exercise for frozen shoulder. Manual therapy includes any movement of the joints and other structures or manipulation done by a clinician (such as a physiotherapist), while exercise in this context includes any purposeful movement of a joint, muscle contraction or prescribed activity. These components combined in a physical therapy interventionA treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. are commonly used to treat frozen shoulder.

The Cochrane reviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. brings together the evidence from 32 trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. with 1836 people. None of the trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. compared the treatments with placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (a dummy, or inactive, treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes.) or with doing nothing. The review shows that a combination of manual therapy and exercise, compared with glucocorticoid injection, probably results in less improvement at seven weeks and a similar number of adverse events. Of the 56 people who had manual therapy and exercise, 26 (46%) reported treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. success, compared with 40 people (77%) of the 52 who had the injection. There were no differences between the groups after 12 months in terms of pain and function. Greater uncertainty remains about other treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. combinations and comparisons.

…and for rotator cuff disease?

I also had a sneaky look at the Cochrane review on manual therapy and exercise for rotator cuff disease, which includes 60 trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. but only one which ‘compared a combination of manual therapy and exercise reflective of common current practice to placebo’. The evidence is high quality (and so reliable) and shows no clinically importantClinical significance is the practical importance of an effect (e.g. a reduction in symptoms); whether it has a real genuine, palpable, noticeable effect on daily life. It is not the same as statistical significance. For instance, showing that a drug lowered the heart rate by an average of 1 beat per minute would not be clinically significant, as it is unlikely to be a big enough effect to be important to patients and healthcare providers. difference between groups in any outcomeOutcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’..

Evidence on electrotherapy

Electrotherapy, such as therapeutic ultrasound or low-level laser therapy (LLLT), may also be offered as part of a physical therapy intervention. A Cochrane review looking at the benefits and harms of these for frozen shoulder found 19 studies with 1249 people. It leaves us with more questions than answers with no or only limited evidence on the benefits and harms of a range of electrotherapy treatments. There is evidence of benefit for only one type of electrotherapy, LLLT, which, when added to exercise, is probably better than placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. in improving pain and function at four weeks and four months. On its own, LLLT may be more effective than placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. at the end of six days of treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes..

Back to Sarah, my physiotherapist

When I return for a second appointment, Sarah and I have both done some homework on the evidence and I have even done the exercises, with maybe a slight improvement. Maybe… Very slight…

So, over to Sarah:

“In my career as a musculoskeletal physio, I have seen and treated many true frozen shoulders, not to be confused with stiff shoulders caused by osteoarthritis. Some practitioners like to x-ray to rule out osteoarthritis, fractures, and rare but serious problems such as secondary metastases (cancers) in the humeral head. Treatments have come and gone as evidence is collected on the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of each. Some physios have very strong personal preferences on how to treat their patients and some favour certain techniques.

Frozen shoulder is one of the conditions that proves problematic for many physios, if I am honest. Most standard physiotherapy treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. such as massage, joint mobilsation, manipulation, passive stretching, acupuncture, electrotherapy can vary widely regarding the evidence and effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms.. But, and this is the bit that does vary from physio to physio, some physiotherapy treatments are poorly evidence-based at un-stiffening a frozen shoulder but very beneficial for pain relief, such as massage or acupuncture. That may be a good clinical decision to get the pain down to allow the patient to start their exercise. I have tried all of the above with huge variances in success, and I have seen the results of more invasive treatments, including steroid injections and manipulation under anaesthetic. Again, the outcomesOutcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’. for the patient vary on a big scale, much like the UK weather.

However, there seems to be gathering evidence in the physio world on the use of eccentric muscle strengthening exercises. These are specific exercises to load a muscle in a lengthened position (think about a biceps curl; well when you straighten the arm out again, that’s loading the biceps in a lengthened position). It seems that a stiff and very painful shoulder does respond to this method. We don’t know how this strategy works yet on the shoulder (we do in the lower limb), but it may be something to do with relieving pain resulting from muscle guarding around the shoulder. Guarding muscles become painful just adding to the misery of an already sore and tight capsule. For me, I have got good results in both reduction in pain and increase in range of movement. The two things that patients want to change! So I tend not to bother with the other treatments now and just concentrate on this exercise based therapy.”

So what now?

After the session learning eccentric muscle strengthening exercises with Sarah, I was pretty sore, so I left it for a day. Then I was away from home and busy (feeble excuses I know…) so I left it a bit longer. That slid into a week or so and then I noticed my shoulder felt a little better, and I had a bit more movement. But I don’t know if this is the result of one intensive exercise session, rest, or just natural recovery, which leaves me not knowing what to do next! The realities of managing a condition and making choices about it!

In the interests of my general health and fitness, I’ve gone back to my Jazzercise classes. I have discovered something too: the walking stick, no longer required for my exercises, is the very thing I need for pulling down the washing line and pushing things onto it. And I’m not forgetting to be thankful that I don’t (yet) need to use it to help me walk.

Join in the conversation on Twitter with @SarahChapman30 @CochraneUK or post a comment here.

References may be found here.

Sarah Chapman has nothing to disclose.

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Updated on 6/22/2005

Frozen shoulder (the medical term is adhesive capsulitis) is a painful condition that can also limit arm movement on the affected side of the body. It is probably the result of an inflammatory process that causes the capsule surrounding the shoulder joint to thicken and contract. As a result, the upper arm bone (humerus) has less space in which to move.

While the exact cause is unknown, frozen shoulder tends to develop after injury, overuse, or surgery that causes a period of immobility. Women are affected more often than men, and between 10 to 20 percent of diabetics eventually develop frozen shoulder. Hyperthyroidism, cardiovascular disease, Parkinson’s disease and clinical depression can also be predisposing factors.

Symptoms typically begin with pain that worsens when you move your arm. Eventually the pain lessens but the range of motion in the affected arm decreases, preventing you from raising it overhead or rotating it outward. Such ordinary activities as reaching into the back seat of a car and even driving (particularly if your car has a manual transmission) can become difficult. This can go on for months, even years.

A combination of medication and home exercise or physical therapy can help relieve the pain and restore range of motion (visit the American Academy of Orthopaedic Surgeons at www.orthoinfo.aaos.org for more information). Conventional treatment also includes over-the-counter anti-inflammatory drugs such as aspirin or ibuprofen, muscle relaxants and the application of heat or ice for pain control. Some doctors recommend cortisone injections to suppress inflammation if other measures don’t help. Arthroscopic surgery to repair the shoulder is a last resort, followed by an exercise program to keep the shoulder mobile.

Before resorting to such drastic measures, I would try acupuncture and osteopathic manipulation; both can be helpful, and both are safer than more invasive measures. I also recommend trying DMSO (dimethyl sulfoxide) topically. You can buy it at your health food store or on the Internet. It penetrates the skin and promotes healing of pockets of inflammation. Make a 70 percent solution of DMSO by diluting a 100 percent solution with distilled water and apply it to the shoulder with absorbent cotton. Let it dry. Apply the solution three times a day for three days. If you don’t see any improvement, stop using it. If you do notice improvement, cut back to twice a day for three more days, then once a day for a final three days. After that your body can continue healing on its own.

Andrew Weil, M.D.

Frozen shoulder natural remedies

Frozen shoulder is a condition also known as Adhesive Capsulitis. We will discuss symptoms, causes and some of the natural remedies that can be followed to alleviate this condition.

It is a condition where one’s shoulder is affected by severe pain and stiffening. The words Adhesive Capsulitis are derived from the Latin word adharens, meaning “Sticking to” and capsule meaning “little container” and the Greek word its meaning is inflammation. Frozen shoulder is a painful and disabling condition often causes great frustration in people.

What are Frozen shoulder symptoms?

In frozen shoulder the pain is usually constant and may aggravate at night. In such cases, movement of the shoulder gets severely restricted. It occurs mostly in people between the age of 40 and 60. About 70% of cases occur in females. If one takes an x-ray of an affected person, the shoulder will appear to be normal and healthy and it cannot be detected.

There are three stages of frozen shoulder, which are-

A) Painful stage.
B) Frozen stage .
C) Thawing stage.

Frozen shoulder mostly occurs in people suffering from Diabetes, Thyroid issues, Chronic inflammatory arthritis, after a chest or breast surgery and after a fracture of the arm.

Frozen shoulder natural remedies-

One should practice mild physiotherapy exercises every day, so that shoulder muscles does not become stiffer.

Apply a paste of Turmeric on the frozen shoulder twice a day or start using Turmeric Curcumin supplements.

Do some stretching exercises. These will help to increase the movements of the arm.

Heating pad is also considered to be one of the effective remedies for frozen shoulder.

Local application of Camphor based topical pain relief oils should help Frozen shoulder condition.

Put 2 to 3 cloves of Garlic in a little mustard oil, boil it, allow this to cool and apply this oil to the shoulder, 2 times a day.

Gentle massage of coconut oil is also advisable.

Always try to consume Vegetable Oil, in moderate quantity, as this will help to lubricate the joints.

Hot and cold compresses or using a pad works well.

Soak a cotton towel in hot water. Then cover the shoulder with this towel for about 5 to 10 minutes. This is effective.

Dietary supplements like Turmeric and Boswellia also plays an important role to help with frozen shoulder.

Addition of fish oil and Glucosamine may be helpful to relieve joint pains.

Intake of calcium rich foods is advisable; these are Beans, soup of Barley, Sprouts, Soup cooked with seaweed. Intake of green vegetables is also advisable.

Spirulina is a natural source of Proteins, Vitamins & minerals. Hence intake of Spirulina along with Black pepper should help with Frozen shoulder.

Some of the above recommended remedies should be helpful to most people. In severe cases one should talk to a Medical Doctor.

Dr. Deo is an expert Herbalist, a consultant and the author of this page.

All the information provided above and opinions expressed above should not be construed as medical advice. This information is provided for educational purposes only. Any statements made above have not been evaluated by the Food and Drug Administration. Any products discussed above are not intended to diagnose, treat, cure or prevent any disease.

  • Frozen Shoulder Exercises and Natural Treatment

    The occasional pulled shoulder muscle is not something to fret over but ongoing stiffness and pain lasting for weeks at a time could be indicative of a frozen shoulder. Nothing like the cold shoulder you give to people you don’t like, this is a real physical ailment that can cause disruption to your life.

    What is Frozen Shoulder?

    This may sound like a trending phrase but the reality is that between 2 and 5 percent of people suffer from this condition at any given time. The general cause is inflammation, which floods the area after immobility or incorrect stretching and flexing. People often develop frozen shoulders after injury to the area or after prolonged time wearing a sling or cast.

    Sedentary lifestyles cause people to move less and the limited range of motions to your arms, chest, and shoulders contributes to the development of frozen shoulder. Also, elderly individuals with medical conditions associated with inflammation are more prone to the development of this painful condition.

    | Related: The Inflammation Factor: The Heart of the Joint Health Matter |

    Frozen shoulder often develops in stages and you will notice persistent pain in the joints or muscles along with stiffness for extended periods of time. If left untreated, it is possible for frozen shoulder to last for a year, which can be very disruptive. Exercise becomes a challenge, normal daily activities become a chore, and sleeping is negatively impacted.

    The longer the pain lasts, the more your mobility is affected and the worse the shoulder pain becomes. Early identification and treatment are the best way to control symptoms and ease pain so you can get back to your normal life.

    The Symptoms to Watch For

    Typically frozen shoulder develops gradually and the symptoms will worsen over time. The symptoms will vary depending on the stage but the general ones to watch out for are indicated below:

    1. Stiffness in and around the shoulder, usually in one shoulder at a time. It is likely that the pain will return to the same shoulder. Once frozen shoulder develops in one arm, there is a 20 to 30 percent chance it will develop in the other arm too.

    2. Muscle, joint and bone pain in and around the shoulder or arms

    3. Limited range of motion

    4. Difficulty moving and using arms normally, such as with reaching, getting dressed, driving, holding objects or carrying things.

    5. Difficulty sleeping comfortably

    | Related: Understanding Our Joints, Cartilage, and The Aging Process |

    Doctors estimate that there are four stages to the progression of the condition with each one lasting anywhere between one and three months; the “pre-freezing” stage, the “freezing” stage, the “frozen” stage and finally, the “thawing” stage.

    The freezing stage is characterized by limited shoulder movement and noticeable pain around the area. Pain can begin to decrease in the freezing stage but stiffness will definitely set in, making movements difficult.

    The frozen stage is marked by a very stiff shoulder that is not painful when resting. The shoulder capsule will be thicker and scarred, limiting your range of motion and causing severe pain when stretching or reaching.

    During the thawing stage your range of motion may improve but you can still expect pain to come and go, particularly at night or anytime pressure is applied to the socket area.

    What Causes Frozen Shoulder?

    Essentially a lack of movement and flexibility are the culprits but inflammation contributes, as well. The shoulder capsule is the section of the joint where the ligaments holding the bones together meet.

    Injury, overuse or surgery can cause irritation to the capsule and bring inflammation to the area. As the shoulder capsule thickens and tightens, the joint becomes constricted, and movement is painful.

    The pain caused by frozen shoulder forces you to use the arm or shoulder less and a downward spiral begins. The initial cause of frozen shoulder is a lack of movement so continuation of this only worsens the condition.

    Initial pain causes stiffness, which reduces mobility which, in turn, causes further pain. Stretching and exercising are therefore the best ways to treat a frozen shoulder and to avoid the continuing spiral of pain and discomfort.

    There are a number of risk factors that can increase your chances of developing frozen shoulder. Most of the affected individuals are women over the age of 40. Women are more likely to experience frozen shoulder than men due to hormonal imbalance.

    Undergoing surgery, which will require immobility during recovery or living a sedentary lifestyle are additional risk factors. In addition, recovery from stroke or cardiac disease ,which affect the nerves in your arm, will also place you at risk.

    The Best Natural Treatments

    While the option of medical treatment involving steroids, painkillers, and numbing medications is available, many people prefer natural treatments. The benefit of the natural methods is that you focus on the underlying issue so the condition is less likely to return.

    Medications will definitely help you ease the pain to get through each day but the approaches below will work to eliminate the problem for a longer period.

    Heat: Heating the shoulder area before any stretching or exercise delivers additional blood to the area, preventing further injury. Application of heat for 10 or 15 minutes or a hot shower followed by some light circular motions is a good way to gradually get the shoulder active again.

    Physical therapy: Lighter exercises at home will certainly help but if the pain is persistent, you should see a physical therapist who can design a regimen of stretches that will loosen the stiffness and support mobility over an 8- to 12-week course.

    Numbing the pain: Aside from painkillers, there are natural alternatives to help you with the pain of frozen shoulder. Essential oils such as peppermint oil are great for reducing inflammation and boosting circulation. Additionally, massage therapy and acupuncture have been proven to help.

    Reduce inflammation: Following an anti-inflammatory diet and taking supplements is the best way to reduce overall inflammation in your body and to prevent future occurrences. Fresh fruit and vegetables, probiotic foods, turmeric, and omega-3 fatty acid supplements are all ideal.

    Exercises: There are several great exercises or stretches for frozen shoulder. Your physician or physical therapist will have a list for you to choose from but the top three recommendations are here for you:

    Pendulum stretch – Relax your shoulders and allow the affected arm to hang down, swing the arm in small circles for ten minutes in each direction. As you notice stiffness decrease, you can do more repetitions.

    Towel stretch – Take a small towel and bring it behind your back, grabbing one side with each hand. The towel should be running vertically down your back. Pull the top arm upwards and the bottom one down at the same time to stretch the shoulder muscles. You want to do between 10 and 20 of these daily, alternating which arm goes on top.

    Armpit stretch – Place the affected arm on a breast-high shelf or countertop. Slightly bend and straighten your knees, coming into a squat, opening your armpit. Twenty times a day for this stretch is beneficial.

    After following a stretching regimen to get your shoulder mobile again, it is a good idea to start exercising regularly. Check with your physician first and make sure you always warm up and cool down appropriately before exercise.

    Always keep an eye out or returning symptoms so you do not re-injure yourself. Ideal exercises include jogging, swimming, water aerobics and cycling, as they keep inflammation down and provide good ranges of movement.

    The Bottom Line

    Frozen shoulder does not have to ruin your life. While it is very uncomfortable, there are so many ways to decrease pain levels and help prevent it from returning. The number one cause is immobility so staying active is essential.

    When the condition arises from forced lack of movement, such as after a surgery, speak with your doctor about what you can do right away. It is important to remember that frozen shoulder is more than just a stiff shoulder but can be very debilitating if not treated. So the last thing you want to do is give it the cold shoulder.

    Read Next >>> Boswellia Serrata Matters to the Health of Your Joints

    Frozen Shoulder

    Frozen shoulder or adhesive capsulitis, is a common condition affecting people generally between the ages of 40–65, especially in people with a history of diabetes, thyroid problems, Parkinson’s, or cardiac disease. Patients with frozen shoulder have progressive loss of range of motion and pain with any motion of the affected shoulder.

    The shoulder is a ball and socket joint, but the anatomy of the shoulder allows for an amazing amount of flexibility. The humeral head, or ball, sits on the glenoid, a very shallow socket. It resembles a golf ball on a tee. Because the socket is so shallow, the shoulder relies on the soft tissue around the shoulder for stability. The labrum, a thickened cartilage layer around the glenoid, and the ligaments and capsule, provide a majority of the stability to the shoulder. The muscles of the rotator cuff and scapula also provide stability.

    Our Approach to Frozen Shoulder

    A frozen shoulder typically heals on its own, although full recovery can take a long time. A good physical therapy program and, for some patients, ultrasound-guided cortisone injections into the shoulder joint can speed the process. Only a small percentage of patients need surgery to get better.

    Our team includes highly trained physical therapists and orthopedic surgeons who specialize in the shoulder. We work together to relieve pain and restore mobility, so patients can return to their normal lives and the activities they enjoy.

    Frozen shoulder will thaw

    Dear Doctor: One of the moms in our car pool had to drop out because she has a frozen shoulder. I’ve never heard of that. What is it, and how did she get it?

    Dear Reader: Frozen shoulder, also known as adhesive capsulitis, is a common and painful condition in which the connective tissues around the shoulder joint gradually become thickened and inflamed. It’s more common in women than men, and it more commonly occurs in people from ages 40 to 60. With a frozen shoulder, previously simple activities like raising your arms to slip into a T-shirt or even reaching up to scratch your head become very difficult.

    To understand the condition, let’s start with the shoulder joint itself. It’s a ball-and-socket joint, which means that the rounded head of the humerus, which is the upper arm bone, fits into a cuplike structure located on the scapula, or shoulder blade. Cartilage, which is smooth and elastic, covers the surfaces of the bones where they meet. It acts as a shock absorber, and its sleek surface helps to reduce friction and smooth movement. Meanwhile, strong ligaments that attach to the “ball” of the humerus and to the shallow “socket” on the scapula hold the parts of the shoulder joint in place. Taken together, this allows for a wide range of motion. In fact, the ball-and-socket joint offers the most freedom of movement of any type of joint in the body.

    When inflammation causes the connective tissues within the shoulder joint to become thick and stiff, the capsule tightens. In some cases, scar tissue forms, which further limits range of motion. All of this makes any kind of movement within the joint, whether active or passive, both difficult and painful.

    Frozen shoulder can develop when injury, trauma or surgery have forced long-term immobility. It is also seen more often in people at risk of developing diabetes, and those with chronic inflammatory arthritis. The condition begins with localized discomfort or pain, which gradually increases over time. It can take from two to 10 months for a frozen shoulder to develop. During the “frozen” stage of the condition, which can also last for months, the joint becomes difficult, if not impossible, to move. The good news is that during this time, pain from the condition may decrease. Eventually, range of motion begins to return to the joint.

    In order to eliminate other potential causes, imaging tests like an MRI or an X-ray may also be used. Treatment focuses on alleviating pain and recovering range of motion. This entails the use of various anti-inflammatory medications, and possibly injections of corticosteroids into the joint capsule. Patients are also taught exercises to stretch the joint capsule, and when recovery begins, strengthening exercises. Infrequently, surgery may be required. Most cases of frozen shoulder resolve within a year or two.

    Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

    5 Things I Should Have Known About Frozen Shoulder

    10 years ago, I knew very little about what a Frozen Shoulder was.

    I had a client at that time who had enough movement in his shoulders to do most things but he could not reach up above his head and he could not scratch his back. Thankfully, for him, most of the important personal functions that need to be performed using the shoulder joint, are done within a fairly narrow range of motion.

    As a well-meaning health professional, I tried everything to help my client improve his shoulder range of motion. I even tried motivational techniques to help my client stick to the exercises when they weren’t working. Little did we know, at that stage of the process, there was nothing that could have been done from a mechanical and therapeutic perspective.

    So what do I know now that would have saved me and my client a lot of time and frustration, not to mention my client’s money?

    1. What is “Frozen Shoulder”?

    Frozen Shoulder is the common name for a condition known as Adhesive Capsulitis. It often starts in a gradual, subtle way when the shoulder stays inflamed for a long time, leading to a thickening of soft tissue around the shoulder joint and a sticking (or adhesion) of structures that would have previously moved independently.

    Adhesive Capsulitis reduces shoulder range of motion in all directions and progresses over a 15 to 24 month period in three phases:

    • Painful/acute (“freezing”) stage: people experience pain and a reduced range of motion that persists from 3 to 9 months;
    • Adhesive/chronic (“frozen”) stage: this is when there is almost a complete loss of shoulder range of motion but pain is experienced only at the end of the range of movement. This phase progresses from the 9 month mark up to the 15 month mark;
    • Recovery (“thawing”) stage: this is when shoulder range of motion gradually improves with minimal pain from the 15 month mark up to 24 months1 after the initial injury.
    1. Who is at risk of developing a “Frozen Shoulder”?

    Researchers have spent a lot of time studying Adhesive Capsulitis and the sort of people who suffer from it1:

    • 2-5% of cases are from the general population;
    • 10-38% have diabetes;
    • 20-30% develop Adhesive Capsulitis in the opposite shoulder;
    • 70% of cases are in women;
    • Adhesive Capsulitis is most common in people older than 40;
    • Adhesive Capsulitis is slightly more common in the non-dominant arm.

    This data helps us to identify patterns in the people who develop Adhesive Capsulitis. However, we are no closer to predicting who will ultimately suffer from a period of Frozen Shoulder.

    1. What causes Frozen Shoulder?

    There are two main forms of Adhesive Capsulitis: Primary Adhesive Capsulitis and Secondary Adhesive Capsulitis. Primary Adhesive Capsulitis describes Frozen Shoulder with an unknown origin. Secondary Adhesive Capsulitis has associated precipitating factors such as a prior injury, shoulder surgery, disuse or prolonged immobilisation of the shoulder or metabolic disorders such as diabetes or thyroid diseases2.

    1. How is Frozen Shoulder treated?

    During the “freezing” and “frozen” stages the most effective treatment is to simply control shoulder pain through analgesics and cortisone injections. The treating clinician will usually notice that their treatment of the affected shoulder is having no effect. This is when it is decided the patient has a possible Frozen Shoulder and a more accurate diagnosis can be made. This seems a little late in the piece but there a currently no other ways of diagnosing Frozen Shoulder.

    During the latter “thawing” stage a greater emphasis is placed on physical therapy and manual therapy3 to restore range of motion and functional strength.

    1. How is Frozen Shoulder going to impact my performance at work?

    Recovery from Adhesive Capsulitis gets slower with age and with the degree of manual labour in a job role1. These factors need to be considered when returning workers affected by Frozen Shoulder back to work.

    Knowing these facts would have saved me and my client with Frozen Shoulder a lot of time. It would have saved my client from my well-meaning but futile attempts at improving his shoulder range of motion and I would have been able to provide a degree of hope to an elderly gentleman who, when we parted company, gave up on trying to improve his shoulder dynamics altogether.

    KINNECT treats frozen shoulders in Cairns, Brisbane, Townsville, Gladstone and a number of other locations around Australia.

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