This condition of the shoulder begins with discomfort and pain in the shoulder and shoulder region. Gradually, both active and passive range of motion will decrease and the shoulder stiffens. The discomfort increases gradually, and in very many cases we cannot see why it occurs. The condition can arise suddenly and without a clear cause. It can arise as a result of trauma to the shoulder, whether from a fall or a blow to the shoulder, and it can also arise after operations that involve immobilisation or inactivity of the shoulder.
The different phases of frozen shoulder
In the first phase, where the pain is greater than the reduction in range of motion, there is an inflammatory state in the joint capsule. There can be a lot of pain both during activity and at rest, as well as at night. This inflammation leads to fibrosis of the joint capsule, that is, the joint capsule stiffens, thickens and contracts. Then you move into the phase where reduced range of motion becomes more evident and the pain decreases. In this phase the pain will be most evident at end ranges and not as much at rest and with limited use. A frozen shoulder can take anything from 1 – 3 years before range of motion and function return to near normal. It is not an unusual condition among those with shoulder problems, and is most frequent in the age group 50 – 60 years.
Treatment of frozen shoulder
Treatment of a frozen shoulder largely involves informing the patient about the condition and helping to adapt everyday activities, both at work and in leisure time. The shoulder should not be irritated too much, and should not be pushed past the pain limit. Painkillers will help in the first phase where the inflammation is very active, and in many cases a corticosteroid injection into the joint will be necessary. When the pain settles, and it is the reduced range of motion that is most challenging, light range-of-motion exercises and some pain-free strength training are beneficial, preferably an individually adapted programme, as each shoulder responds differently to exercise in this phase. As the shoulder allows, both the range of movement and the load of the training can be increased gradually and the function of the shoulder improves over time. Yes, this takes time, as mentioned earlier, but it passes, and our most important task as practitioners is "education" of the patient so that you can make the best possible arrangements for yourself and feel that you can manage it yourself.
Stay active, but adapt!
The article was written by naprapath Kine Hauger Sorte.
If you want to read more about frozen shoulder, you can read one of our previously published posts here.
References
- Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: A randomized controlled trialRawat, Pallavi et al.Journal of Hand Therapy, Volume 30, Issue 3, 235 – 241.e8
- Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar;103(1):40-47. doi: 10.1016/j.physio.2016.05.009. Epub 2016 Jun 21. PMID: 27641499.
- Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Elizondo CM, Maignon GD. Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis: A Randomized Controlled Trial. Am J Sports Med. 2016 Feb;44(2):474-81. doi: 10.1177/0363546515616238. Epub 2015 Dec 9. PMID: 26657263.