What is a frozen shoulder? What can aid recovery and provide relief? What diseases and disorders need to be investigated as a potential underlying cause? We answer all these questions and more.
1. A frozen shoulder, also known as adhesive capsulitis, is characterized by pain and stiffness of the shoulder joint.
Irritability of structures under the coracoacromial ligament leads to fibrosis and contracture. Essentially the shoulder capsule adheres to the humeral head. In about 90% of patients, the pain associated with this condition usually lasts 1 to 2 years before subsiding!
2. There are 3 stages that occur with adhesive capsulitis.
Stage one involves a generalized ache and stiffness in the shoulder. Pain can be worse at night, especially when lying on that shoulder, or when the shoulder is moved close to the end of its range of motion, and with certain combined movements, as these stretch the joint capsule. Movements like when brushing one’s hair, reaching for a seat belt overhead, or reaching for a back pocket or bra strap. Generally, movement is restricted in all directions on passive and active motion which can differentiate it from other conditions like synovitis of glenohumeral joint or rotator cuff tendinopathy.
Stage two is the adhesive phase. Limitation of movement increases in all directions, although the pain may have lessened a little. A constant pain at rest may occur but the greatest discomfort is experienced at extreme ranges of motion. The pain is aggravated by stress, exposure to cold or vibration, changes in the weather and activities involving repetitive movements of the affected shoulder.
Stage three is the recovery or thawing phase where the pain progressively decreases, but there is still marked restriction in range of motion. Slowly over 12 to 24 months the stiffness improves but recovery is frequently incomplete, with 10% experiencing significant long term issues and 40% experiencing a slight, persistent decrease in range of motion.
3. A frozen shoulder can be due to a specific event or injury or an underlying disorder.
It is vital an underlying disorder is investigated or improvement is likely to be poor. If under 40 years of age, it is more likely some underlying disease process needs to be addressed.
Some causes of secondary adhesive capsulitis can include:
Diabetes mellitus (common)
Surgical trauma
Nerve injury or pressure e.g. thoracic outlet syndrome, cervical radiculopathy
Disuse of the joint due to surgery, injury, disease or stroke.
Autoimmune, inflammatory or endocrine disease – e.g. Rheumatoid arthritis, Scleroderma, hypo or hyperthyroidism, polymyalgia rheumatica, hypertriglycedemia.
Tumours – eg. lung cancer, Pancoast tumour irritating the brachial plexus
Referred pain from organs and tissues like the heart, neck, diaphragm, liver or spleen eg. pulmonary tuberculosis, chronic pulmonary disease, after a myocardial infarction (heart attack)
Parkinson’s Disease – increases risk of a frozen shoulder by 4-5X compared to healthy populations. Frozen shoulder is often an early sign of Parkinsons and can precede a tremor by years.
4. Treatment of a frozen shoulder can be frustrating and slow.
Most cases will eventually improve, but it may be a process that takes many months or even years. Any underlying disorder must be addressed but initial treatment aims to decrease inflammation and increase the range of motion of the shoulder.
Natural pain relievers can include turmeric or ginger tablets and essential oils like frankincense, copaiba, wintergreen, basil and lemongrass. (See Essential oils for Frozen Shoulder Relief).
Trigger point therapy of the muscles around the shoulder (particularly the subscapularis muscle) and friction over the fibrous cuff can be extremely helpful.
Sufferers can also benefit from chiropractic care with cervical spine adjustments to improve the mobility of the spinal joints in the neck. Many chiropractors can also perform adjustments to the shoulder to help to break up adhesions. Improving the brain-body connection with chiropractic adjustments can also aid pain perception.
5. At home stretching and strengthening exercises can be helpful.
The following exercises and stretches are frequently recommended.
Prolonged postures that shorten the subscapularis muscle should be avoided as they are likely to increase pain. So, when driving, standing or sitting for long periods it’s important to stretch the affected shoulder.
Sleeping is often another aggravating posture so it is best to sleep on the unaffected side, with a pillow placed under the affected arm. You can also place a pillow behind you to alert you if trying to roll over onto the affected side.
Stretching with heat
Warm the shoulder with moist heat for 10-15 mins.
Then lie on your back on a bed and with the palm up gently hang the arm off the side of the bed to feel a gentle stretch across the front of the shoulder. Place moist heat also on the front of the shoulder. Replace the heat packs/cloths every 10 minutes to maintain the heat. Perform this stretch for up to 45 minutes. There should be discomfort, but no pain.
During the last 10 minutes, ice should be applied, instead of moist heat.
Repeat daily, up to 5 x per week.
“Climbing the wall” exercise: The patient faces a wall and places the hand flat against the wall. Using the fingers to crawl, spider-like, upward, the goal is to reach as high as possible, pausing every few inches to hold the position for 30 seconds. The same manoeuvre is then performed with the arm extended to the side. At each session, an effort is made to reach a little higher.
Codman exercises: Sitting sidewise on a chair, the affected arm is draped over the chair’s back, with the chair back in the armpit. The dangling arm is swung in increasingly large circles for 30 seconds, and then the circles are repeated in the opposite direction.
Rotation exercises: Alternately reach for the back of the head (as if combing your hair) and then reaching behind the back (as if reaching for a zipper). This takes the shoulder through internal and external rotation.
Conclusion
Addressing any underlying or secondary causes of a frozen shoulder is essential to speed healing and recovery. Chiropractic care, muscle trigger point therapy, home exercises and even essential oils can also be of benefit. Although eventually, a frozen shoulder will resolve, proactive care is highly recommended for relief and prevention of a recurrence.
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