If you experience any kind of joint pain or notice that you are unable to perform certain movements like you used to, then visit Atlanta Physical Therapy for a physical examination. Sometimes joint pain can be temporary and caused by something as simple as sleeping in the wrong position, while other times pain can be an indicator of something more serious going on, like frozen shoulder.
What Is Frozen Shoulder?
In the medical field, adhesive capsulitis refers to inflammation and restriction of movement in the shoulder joint. This condition is more commonly known as frozen shoulder. Pain in the shoulder is one of the first signs and symptoms of frozen shoulder, but if you wait for the pain to go away on its own, you risk this condition affecting your range of motion in your shoulder joint. When the structures of the shoulder joint become aggravated or inflamed, certain movements may be restricted.
The shoulder joint is a ball and socket joint where three bones come together: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The humerus has a rounded knob at the top that fits into a shallow socket along the shoulder blade. The shoulder capsule is made up of strong connective tissues that surround the joint and help it function properly. When the joint is aggravated, the shoulder capsule can start to thicken and tighten, causing stiffness and pain.
What Does Frozen Shoulder Feel Like?
The first sign of frozen shoulder starts with pain and discomfort in the shoulder joint. Then, you will start to notice the shoulder joint seems stiff and more difficult to move without making the pain and discomfort worse. Eventually, frozen shoulder can develop to where you start to lose the ability to move your arm and shoulder in certain directions, or you lose mobility in the area altogether. There are three stages of frozen shoulder because symptoms of this condition tend to develop slowly.
The 3 Stages of Frozen Shoulder
Here are the 3 stages of frozen shoulder and what to expect during each stage.
Freezing Stage
The freezing stage refers to the beginning of frozen shoulder when the pain and stiffness first start to set in. Certain movements might make that pain and discomfort worse, and you might start to avoid certain movements because of this. During this stage, you will slowly start to lose the range of motion in your shoulder joint. The pain will become increasingly worse over time, and this stage lasts for an average of six weeks.
Frozen Stage
When you enter the frozen stage, you may experience less pain though the stiffness will still continue to bother the shoulder joint. As the joint continues to stiffen, it will make certain arm and shoulder movements more difficult. The frozen stage can last for 4 to 6 months, which can significantly impact your daily routines and activities.
Thawing Stage
The frozen shoulder thawing stage refers to when you start to regain the range of motion in your shoulder joint. Your mobility will begin to improve, and you may start to complete tasks you were previously unable to achieve. As you start to regain movement in your shoulder joint, you will be able to regain normal strength in the area as well. The thawing stage can take six months to 2 years for you to regain full range of motion in the affected shoulder joint.
What Causes Frozen Shoulder?
Frozen shoulder doesn’t always have an obvious cause, though it does occur more often in people who have recently restricted shoulder movement due to a recent surgery or injury. Prolonged or reduced immobility can aggravate the bones, ligaments, and tendons that make up the shoulder joint. If the parts of the shoulder joint become weakened while you heal from a shoulder or arm injury or surgery, the shoulder capsule may thicken and tighten around the joint, restricting movement and affecting the range of motion. Common arm and shoulder injuries that may require reduced mobility or full immobilization include a rotator cuff injury or a broken arm. Scar tissue can also build up after an injury in or around the shoulder joint, which can also put pressure on structures in the shoulder joint and restrict movement. Recovery from a surgery, such as a mastectomy, may also call for reduced mobility of the shoulder and arm joints as part of the healing process. A recent stroke can also make you more susceptible to developing frozen shoulder.
Common Risk Factors
In addition to reduced mobility or recent immobility from surgery or injury, other common risk factors for frozen shoulder include age, sex, and certain medical conditions and diseases. People over the age of forty are at greater risk for developing frozen shoulder, and this condition is more prevalent in women. Certain diseases that may increase your risk for frozen shoulder include diabetes, cardiovascular disease, tuberculosis, overactive thyroid, underactive thyroid, and Parkinson’s disease. Diabetes and frozen shoulder are commonly linked because blood sugar levels can impact the protein known as collagen, which makes up the connective tissue in the shoulder capsule.
How Is Frozen Shoulder Diagnosed?
If you start to experience pain and stiffness in your shoulder that is making movements more and more difficult, then speak to your doctor as soon as possible. In order to confirm a diagnosis of frozen shoulder, your doctor will want to review your medical history, perform a physical examination, and may also utilize diagnostic imaging tests to get a better look at the impacted area.
Medical History
Your medical history will help your doctor determine your risk factors for developing frozen shoulder. Any recent injuries or surgeries are important to note, even if they did not directly affect your shoulder. For example, if you were recovering from a surgery that required you to reduce mobility in your upper body, then your shoulders and other joints may have developed stiffness and weakened during that time. Your doctor will also want to know if you have certain medical conditions that make you more at risk for developing frozen shoulder, such as diabetes or Parkinson’s disease. Women with thyroid issues may also be more susceptible to frozen shoulder, so your doctor may want to see lab results of recent tests to get a better indication of these important health details.
Physical Exam
Your doctor will then want to perform a physical exam. During a physical examination, your doctor will want to know where you are experiencing pain and other symptoms. They will also want to set a baseline for what movements you can complete, your current range of motion in the shoulder joint, and whether or not your symptoms get worse with certain movements. For example, your doctor may ask you to hold your arm straight out, raise it up above your head, and rotate it behind you before bringing it back around. Your doctor may also ask you to raise your arm out to your side, parallel with the ground, and test certain shoulder and arm movements from this position.
Diagnostic Imaging Tests
Diagnostic imaging tests can also provide your doctor with more information on what is going on with your shoulder joint. For example, X-rays of the shoulder joint can help rule out any fractures or broken bones because these scans provide black and white images of the bones and cartilage in the body. Your doctor may also want to run CT scans or an MRI to get a more detailed look at the bones as well as the soft tissues that make up the shoulder joint, such as the ligaments, tendons, and shoulder capsule. These scans can also help rule out other potential diagnoses and causes for your symptoms.
What Treatment Options Are Available for Frozen Shoulder?
If you think you are developing frozen shoulder, then talk to your Atlanta physical therapy doctor to get started on effective treatment options right away. Physiotherapy for frozen shoulder can help with pain relief and restoring movement and strength to your affected shoulder. Most cases of frozen shoulder will require medical intervention by a doctor to avoid complications like chronic pain. In order to regain full range of motion in your affected shoulder, here are treatment strategies for frozen shoulder.
Managing and Relieving Pain
Part of your treatment process for frozen shoulder will involve managing and relieving your shoulder pain. During the freezing stage, over-the-counter pain relievers can help to reduce pain and inflammation in your joints. Your doctor may also recommend prescription medications or injections to help manage and relieve your pain. Steroid injections like corticosteroids have been approved for use in managing pain for some cases of frozen shoulder. In addition to medications, physical therapy for frozen shoulder can also help to reduce your pain and discomfort naturally, with gentle stretches to help reduce stiffness and improve circulation to the area.
Restoring Range of Motion
During and after the frozen stage, where your shoulder joint has stiffened and restricted many daily movements, your physical therapist can help you restore your range of motion. A frozen or stiffened shoulder can prevent you from effectively relying on your shoulder joint, which is actually the joint with the widest range of motion in the whole body. Frozen shoulder physiotherapy works in restoring your range of motion with gentle and safe stretches and exercises to help improve mobility.
Stretching & Exercising the Joint
Physiotherapy for frozen shoulder will include stretches and exercises that target the affected shoulder and arm. This may include a combination of both passive and active stretches. Passive stretches refer to assisted stretches where you may relax your muscles and allow your physical therapist to move your arm in certain directions. You may also use supports to help stretch certain muscles in your arm and shoulder. Strengthening the rotator cuff will help provide more stability to the shoulder joint. When you work with a physical therapist for frozen shoulder, you can engage in stretching and exercising through each stage of the condition to help reduce your symptoms and your recovery time.
3 Signs That Frozen Shoulder is Starting to Thaw
Here are 3 signs that your frozen shoulder is starting to thaw.
1. Decreased Shoulder Stiffness
One of the first signs that your frozen shoulder is starting to thaw is that you start to notice your shoulder isn’t as stiff as it used to be. As your shoulder starts to loosen, you may also notice a decrease in tension in your shoulder, arm, and even your neck and back. Once the shoulder capsule loses its tightness, you will slowly start to regain certain movements.
2. Regain Lost Movements
Once you move into the thawing stage, you will start to regain movements you may have temporarily lost. For example, many people lose the ability to raise their arms to a certain height. If you were unable to raise your arm to parallel with your shoulder to grasp certain items in front of you during the frozen stage, then you might start to regain these movements that used to be part of your everyday routine.
3. Improved Range of Motion
As your frozen shoulder starts to thaw, you will also notice an improvement in your range of motion. Because the shoulder joint is so mobile, an improved range of motion can start to impact your daily life in meaningful ways. You may be able to start fully extending your arm out to the side, in front of you, and even begin to reach above your head. As you start to see improvement in your range of motion, be sure to talk through these movements with your physical therapist to avoid overdoing it. Your physical therapist can help support you through the thawing phase so that you can heal effectively and prevent future development of frozen shoulder.
We will make your shoulder our priority! Visit AICA Orthopedics for frozen shoulder physiotherapy and learn how our team of physical therapists can help at a location near you!
Sources
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Uppal, H. S., Evans, J. P., & Smith, C. (2015). Frozen shoulder: A systematic review of therapeutic options. World journal of orthopedics, 6(2), 263–268. https://doi.org/10.5312/wjo.v6.i2.263
