Frozen shoulder happens gradually, with symptoms coming on slowly and then lessening over time. The good news is that frozen shoulder usually goes away on its own. While you're waiting for your frozen shoulder to resolve, there are ways to lessen the pain and get your shoulder moving again.
Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.
This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.
- Stage 1: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.
- Stage 2: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts from four to nine months.
- Stage 3: The "thawing" or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.
Risk factors for frozen shoulder include diabetes, stroke, accidents, lung disease, connective tissue disorders, and heart disease. The condition very rarely appears in people under 40.
Frozen Shoulder and Diabetes
Diabetics are at significantly higher risk of developing frozen shoulder, compared with non-diabetics. This is believed to be related to collagen. Collagen is part of the foundation of both tendons and ligaments. It is a component that binds the bones of a joint together tightly and securely. Glucose molecules connect to collagen. With diabetics, the connection of the sugar molecules to collagen can cause unusual collagen deposits to appear in the shoulder's tendons and cartilage. This accumulation can limit the capacity for the joint and ligaments to stretch with movement and result in severe stiffness and pain of the shoulder.The combination of cellular inflammation (caused by the diabetes or some other pathology), high blood glucose levels, and diabetic drugs can gradually trigger the development of frozen shoulder. However, your doctor is not going to admit that his diabetic drug therapy has anything to do with your frozen shoulder. In fact, he/she will take this opportunity to convince you to take even more drugs!
Note: By their nature, since most drugs are toxic and inflammatory, it is imperative that you eat detox foods, anti-inflammatory foods (i.e. wild salmon, raw vegetables, raw juices) and antioxidant-rich foods (i.e. bright-colored vegetables, some fruits, legumes) while avoiding the foods that cause inflammation.
Causes of Frozen Shoulder
Injuries and Conditions: Sometimes shoulder trauma, such as a rotator cuff injury, is the cause of a frozen shoulder. It would be wise to have a doctor check for shoulder problems after an injury, to diagnose and ensure proper treatment. Medical conditions that can cause a frozen shoulder include tendinitis and bursitis.
Surgery: Any surgery on the chest or breast areas provides a patient with a potential risk for a frozen shoulder. This condition occurs because the shoulder cannot be moved, either because of a cast, sling or temporary pain. Because the shoulder is immobilized, the joint is not being used and becomes stiff. Any surgery on the shoulder area also can cause a shoulder to become frozen.
Disease: Some diseases and conditions increase the risk of a frozen shoulder. Individuals with diabetes or other endocrine disorders, chronic inflammatory arthritis, Parkinson's disease or heart disease may will develop frozen shoulder. To decrease the risk of a frozen shoulder, any shoulder problems should be closely monitored. See your doctor if a shoulder suddenly causes discomfort. Diabetes is a risk factor for frozen shoulder, affecting about 20% of people with diabetes.
Physical Characteristics: Both age and gender can affect an individual's chance of frozen shoulder. A frozen shoulder will occur more often in women than men. People who are middle-aged, 40 to 60 years old, are the most commonly affected. Individuals who have had a relative suffer from a frozen shoulder could develop one as well, since there may be a genetic link.
Lack of Use: If a shoulder feels stiff or uncomfortable, making you reluctant to move it, it becomes stiffer. The capsule of connective tissue becomes thick around the joint, resulting in frozen shoulder. The capsule could also become inflamed. To deal with the pain of a frozen shoulder, anti-inflammatory medications.
Frozen Shoulder Treatment
Stiffness makes it difficult to move the shoulder normally, including reaching overhead and behind you. The cause is not fully known, but involves the capsule around the shoulder joint thickening and contracting, according to the American Academy of Orthopaedic Surgeons. Frozen shoulder often affects diabetics. The condition can be controlled, but recovery can take several months.
Treatment may be painful and taxing and consists of physical therapy, medication, massage therapy, hydrodilatation or surgery. A doctor may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs, but drugs don't solve the real problem.
The condition tends to be self-limiting and may resolve itself over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.
The following non-drug therapies may help to alleviate the pain and discomfort, but you must be careful not to cause more damage.
Frozen Shoulder Stretching
Before stretching, prepare your muscles by applying heat. Take a warm shower or bath. Be cautious when beginning to do stretching exercises. Exercises to help increase your range of motion should be done early on in your recovery, but be careful not to worsen the condition. If you feel any sharp pain while stretching, stop immediately and call your doctor.
The weighted pendulum stretch: While standing or sitting, relax your shoulder, and keep your arm vertical. Hold it close to your body. Hang your shoulder downward, balancing with your other hand on a table or chair. Swing your arm back and forth and side to side. Make small circles. Do this once or twice a day after heating for three to seven days. Then, do the exercise by adding a small amount of weight (1 or 2 pounds) each week. Slowly increase the range of the movements--increase the diameter of the movements up to 2 feet. Minimal pain should be felt while doing the pendulum stretch. You can do the exercise immediately after an injury or after receiving a steroid injection in the joint.
Passive stretches: Do these after the pendulum exercise. They will help loosen the shoulder and restore your range of motion. Do 10 to 20 sets once or twice a day for several months.
Arm pitch stretch: Use your unaffected arm to lift your affected onto an object that is chest high, such as a dresser. Bend your knees, and open the arm pit. Push the affected arm farther with each set.
Finger walk: Face a wall, with your arm bent. Use your fingers to walk up the wall, raising your arm up to shoulder level.
Towel stretch: Use a 3-foot towel; hold it with both hands behind your back. Hold it at a 45-degree angle. Use the upper, unaffected arm to pull your arm toward your lower back.
Frozen Shoulder Strengthening
Strengthening exercises should be done after range of motion exercises. Rest for a couple of minutes, and then do 10 to 15 sets of each exercise once a day. Hold each position for five seconds. A flexible rubber tube or large rubber band should be used. You may feel slight soreness from the exercises. If you feel severe pain, stop the exercises for a few days.
Outward rotation exercise: Hold your elbows close to your sides at 90 degrees. Hold the rubber band horizontally in your hands. Rotate your forearm on your affected side outward, and hold for five seconds.
Inward rotation exercise: Hold your elbow at 90 degrees, close to your side. Hook the rubber band on a door handle. Grasp the rubber band with one hand. Rotate your affected forearm towards the body and hold.
Abduction exercise: Bend your elbows to 90 degrees. Place the rubber band around your arms near your elbows. Lift your arms about 5 inches away from the body and hold the position.
Other Non-drug Remedies
In addition to careful exercises, you can do other things at home to address your frozen shoulder. Limit your activity. Avoid any overhead reaching and lifting. Take pain relievers, such as acetaminophen or a nonsteroidal anti-inflammatory drug (ibuprofen). These can be used for temporary relief. Ice the shoulder joint with a wrapped ice pack. Ice it every 15 minutes every four hours or so to reduce pain.
Doctor Remedies
As a last resort, if home remedies do not cure the frozen shoulder, see a doctor. A doctor will start you off with an anti-inflammatory medication such as prescription strength naproxen. He will probably want you to take that for several weeks before moving onto any more serious medications.
Corticosteroids may be offered as a next step. Corticosteroids are injected directly into the shoulder to bring down swelling, relieve pain and encourage the muscle to relax. These injections are not a long term solution, however, and if they do not help quickly the doctor will most likely refer you to a physical therapist for more help.
Surgery: If all else fails, surgery can be done to attempt to cure the frozen shoulder. Your doctor may first put you under general anesthesia and manipulate your shoulder to try to loosen it up. You are put under because this can be quite painful.
If your doctor believes there is actual damage to the shoulder joint itself, he may decide to operate. Invasive surgery can be done to remove scar tissue or fix any other problems within the joint. This is reserved for extreme cases, most frozen shoulders do not require such extreme measures.
Warning: Unfortunately, be aware that drugs and surgery can make the frozen shoulder worse. Make certain that you have exhausted all other possibilities.
Pain Relief Strategies
Frozen shoulder causes the shoulder to lock up and limits shoulder joint mobility. This can be a painful and frustrating condition that may greatly impact a person's function in everyday life. It's important to find pain relief from frozen shoulder since the condition can cause even the simplest tasks to be difficult.
Physical Therapy: Physical therapy is used the most to provide pain relief from frozen shoulder. A physical therapist will work with you to increase mobility and to build up muscle strength in the shoulder area. Part of your physical therapy program will be to do home-exercises to further increase mobility. It's vital to do these exercises as instructed to gain the most pain relief from frozen shoulder.
Heat Applications: Heat helps to relax the muscles in your shoulder and reduce pain. You should apply a mild heat several times daily. Use a heating pad an hour before going to sleep at night. You can take a warm compress to bed with you in the evenings to place under your frozen shoulder. Never use a heating pad in bed because accidental injuries could occur if you fall asleep with one turned on. You can also put an extra pillow under your frozen shoulder at night to reduce pain in case you roll over on the shoulder.
Massage: Gently massage the frozen shoulder several times a day. You can massage after a heat application to further increase mobility and to reduce the pain. Massage the armpit area, shoulder and back area near the shoulder. Don't forget the neck area near the shoulder as well. If you're unable to do self-massage, ask a family member or friend to assist you.
Dietary Supplements: Some dietary supplements seem to help with frozen shoulder pain because they reduce inflammation and rigidity. You should ask your health care provider, who is treating your frozen shoulder, about adding fish oil and glucosamine to your diet. Find out what the recommended dosage would be for your particular case and other medical conditions.
Anit-Inflammatory Medications: Part of the pain associated with frozen shoulder is inflammation. You can take over- the-counter anti-inflammatory medications, according to the bottle labels to help reduce the swelling and reduce the pain. If the pain is very severe, the health care provider might order a prescription strength anti-inflammatory to take for pain relief.
Cortisone Shots: One way to increase mobility of a frozen shoulder is with cortisone shots. These injections are given directly into the shoulder area. Typically, there is increased pain, swelling and tenderness at the injection site for several days following the injection. Once the injection reaction has cleared up, you can find a great deal of pain relief from frozen shoulder. Injections are often administered once every three months, but your orthopedic specialist would decide your schedule for further treatments.
Advanced Therapies
There are alternative therapies for a vastly improved level of treatment for shoulder injuries and chronic frozen shoulder pain. However, you must be very careful and do your research before considering any alternative therapy.
Frozen Shoulder injuries are very common injuries and they can persist for years unless treatment is properly addressed. Anyone who has had one will tell you that they are incredibly painful and very hard to heal.
The exact cause of frozen shoulder injuries is not known. However, it is widely believed that frozen shoulder injuries are caused by inflammation of the joint lining which causes scar tissue to form around the joint. This scar tissue restricts movement in the shoulder causing it to 'freeze' and can be very painful. It is also believed that incomplete healing of a previous shoulder injury can lead to frozen shoulder as incomplete healing from the initial injury creates a build up of scar tissue and inflamation in the shoulder joint.
It's just not possible to stop everything and rest the injury properly. What ends up happening is we continually reinjure the shoulder through our daily activities further setting back our recovery.
Constant re-injury needs to be avoided at all costs. You know when it happens - that feeling of pain when you move the wrong way. This constant reinjury delays the healing process, but what's worse is that every re-injury and additional healing cycle increases the amount of scar tissue that builds up in the muscle. Scar tissue is hard, inflexible, and tough to get rid of. The more scar tissue that develops, the more you lose the range of motion for that shoulder. This is going to mean that your shoulder doesn't perform as well as it once did and it makes it much more prone to injury again later on.
If you have a shoulder injury, it's very important to heal it quickly and completely. If you don't, it may plague you forever.
Shoulder Wrap Therapy
One of these alternative therapies used by atheletes is called the RICE formula for treating inflammation and pain: R - Rest, I - Ice, C - Compression, E - Elevation.
Top professional athletes use these types of therapy to heal their injuries every single day. The reason why pro athletes heal so quickly is because they get these treatments 3 times each day every single day. That's what it takes to heal quickly - regular quality therapeutic treatment. Like any medicine, you need the right dose to heal. Going to expensive physio therapy 2 times per week is like taking a $50 Tylenol every other day to cure a chronic migraine. It's just not enough treatment to get on top of the problem.
It appears that a high quality shoulder wrap can provide the best combination brace and cold therapy for frozen shoulder injuries and can also be very effective for treatment of shoulder injuries such as pulled muscles, tendinitis and bursitis. These shoulder wraps offer compression, support and cold therapy all at the same time.
A high quality shoulder wrap should fit perfectly and be extremely durable. They support your shoulder and apply gentle pressure to your injury at the same time. The wrap with a properly shaped non-migrating gel pack keeps the cold delivering gel over the entire injured area. There's nothing magic about RICE; your doctor and therapist will tell you RICE works to give you the best cold and compression on the planet.
Cold compression wraps work because they interrupt and slow nerve and cell function in the damaged area. Once blood vessels are damaged they can no longer carry oxygenated blood to the damaged tissue and therefore cells begin to break-down. The deep cold provided by the wrap slows cell function thereby reducing cellular break-down.
Furthermore, because the cold wraps serve to numb the nerves, the wraps also reduce pain! In the early days or weeks of your injury the inflammation is part of your body's reaction to try to immobilize the injured area. Unfortunately this inflammation also strains the surrounding tissue and causes pain. Cold compression braces provide the support and reduce the inflammation giving your shoulder the support it needs without the usual pain.
Ultrasound Therapy
The only way to heal your frozen shoulder is to break down the scar tissue that caused your shoulder to freeze. The most effective and non-invasive way to break down scar tissue is with ultrasound therapy.
Different kinds of ultrasound have many uses. Ultrasound in one form is used as a safe method for examining unborn babies. Another kind is also used for examining the quality of a weld on metal pipes. It is used as a skin rejuvenation tool for 'anti-aging' and another form is used as a superior therapeutic tool for healing injured tissue and breaking down scar tissue.
However, the same machine isn't used for all these applications. For each special use, a different and unique kind of ultrasound machine is required. For your frozen shoulder, you require an ultrasound machine that is specifically designed for treatment of soft tissues injuries like frozen shoulder. The wrong kind of ultrasound isn't going to cure your frozen shoulder.
References
- ^ Jayson, M. I. V. (1981). "Frozen Shoulder: Adhesive Capsulitis". British Medical Journal (Clinical Research Edition) 283 (6298): 1005–6.doi:10.1136/bmj.283.6298.1005. JSTOR 29503905.
- ^ a b "Frozen shoulder - Causes". Retrieved 2011-07-05 work=.
- ^ "Questions and Answers about Shoulder Problems". Retrieved 2008-01-28 work=.
- ^ "Your Orthopaedic Connection: Frozen Shoulder". Retrieved 2008-01-28 work=.
- ^ a b c Ewald, A. (2011). "Adhesive capsulitis: A review". American family physician83 (4): 417–422. PMID 21322517.
- ^ Tveitå, Einar Kristian; Tariq, Rana; Sesseng, Solve; Juel, Niels Gunnar; Bautz-Holter, Erik (2008). "Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial". BMC Musculoskeletal Disorders 9: 53. doi:10.1186/1471-2474-9-53. PMC 2374785. PMID 18423042.
- ^ Baums, M. H.; Spahn, G.; Nozaki, M.; Steckel, H.; Schultz, W.; Klinger, H.-M. (2006). "Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis". Knee Surgery, Sports Traumatology, Arthroscopy 15(5): 638–44. doi:10.1007/s00167-006-0203-x.
- "Frozen Shoulder" from the American Academy of Orthopedic Surgeons
- Siegel, Lori B.; Cohen, Norman J.; Gall, Eric P. (1999). "Adhesive capsulitis: a sticky issue". American family physician 59 (7): 1843–52. PMID 10208704.
- Radiology image sequence demonstrating CT guided shoulder hydrodilatation
- "Frozen Shoulder" from Harbor Physical Therapy, Baltimore, MD.
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