What is frozen shoulder?
Frozen shoulder or medically referred as adhesive capsulitis, is the inflammation of capsule and synovial membrane of shoulder joint. Here, the tissues around the shoulder joint become stiff due to formation of adhesions and largely restrict the joint’s range of motion.
Prevalence and risk factors
Frozen shoulder tends to occur after the age of 40. Women are more affected than men. However there are certain factors which may pose an individual at potential risk. They are:
- Cervical disc disease
- A ‘wrench’ or fall on the shoulder.
- Shoulder dislocation or fracture in the arm bone.
- Heart diseases
Presentation and symptoms of frozen shoulder: whether one is suffering from frozen shoulder becomes evident with the following symptoms:
- A dull pain which becomes more intense over weeks.
- Sharp pain produced at the limit of active or passive motion.
- Gradual spreading of pain till elbow and neck.
- Pain worsens at night.
Loss of movements
All movements are severely restricted due to pain initially and tightening of fibrous capsule later.
Muscle spasm and weakness
Muscles around the shoulder may go into a protective spasm in order to not damage themselves further. Gradually, muscle weakness may set in.
The person is incapacitated because of not being able to do simple tasks like reaching out to high shelves, combing hair and other daily activities.
The smaller and the bulkier muscles of shoulder become tight. Due to this the ‘gleno humeral’ rhythm of shoulder is often disturbed making the shoulder girdle held in elevation along with chin and head thrusting forwards. The patient generally adopts this posture subconsciously to give comfort to the painful shoulder.
Also, these symptoms are associated with lot of anxiety levels or depression which must be brought down before full recovery is expected.
An overview of treatment options
Capsulitis is one of the most difficult conditions to treat. The treatment should always be based on a thorough physical examination and confirmed diagnosis by X-rays, MRIs etc.
Depending upon the severity, the treatment consists of physiotherapy, corticosteroid injections, manipulation under anesthesia and surgery.
The physiotherapy treatment for a frozen shoulder
Physical therapy has considerable help to offer, based on revised examination by the therapist and it is enhanced by regular analysis of the progress.
Modalities like interferential therapy (20 mins) and ultrasound (8 mins) are given for pain relief and facilitating the removal of inflammatory exudates. Ice therapy for 10 mins helps some patients and hot water fomentation helps to relax muscle spasm.
Strictly to be performed by a trained therapist only. Accessory movements are given to restore the gliding within the joint and improve rotations when fibrous resistance is the main limiting factor. This is followed by passive and slow stretching which aims at softening the thickened muscle fibres encircling the shoulder joint.
Posture and position sense
Total spinal posture with shoulder and pelvic symmetry require attention, and activities should be done to stretch the tight spinal structures.
- Bending a little holding a weight of 1kg and moving the arm like a ‘pendulum’. This applies traction and increases traction on the shoulder.
- Walking the fingers up the wall.
- Wheel and pulley exercises.
- Towelling behind back.
- Raising the arm sideways and forwards while watching in a mirror.
- Exercising with one kg weight helps improve muscle strength.
Patient is taught to recognize the tension in the shoulder muscles during everyday activities.
Used to balance gravity and to provide support to the arm.