The American Academy of Orthopedic Surgeons (AAOS) has defined frozen shoulder (adhesive capsulitis) as a condition characterized by a progressive limitation of active and passive shoulder motion. According to the AAOS, the severity of the condition can vary, but however severe the condition, there may not be radiographic findings other than a mild form of osteoporosis (osteopenia). While frozen shoulder is the most common term used to describe the condition, it is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis.
The condition, which is characterized by severe shoulder pain and stiffness, occurs most commonly in the fifth and sixth decades, and is more common in women than in men. It is very rare for the condition to manifest in people under 40 years of age. The one good thing about the condition is that it commonly occurs in the non-dominant shoulder, and it never strikes both the shoulders at the same time. However, there is a small possibility that a person with one ‘frozen shoulder’ could develop the condition in the other shoulder within five years.
Thankfully, the condition is self-limiting. Once it runs its course, which usually lasts for two-three years, the shoulder ‘thaws’, the pain subsides, and the shoulder gets back to almost its full range of motion. However, statistics show that close to 40 percent of patients have mild yet persistent pain beyond three years, and about 15 percent of patients could suffer the symptoms for a long time.
While there is always the option of surgery, where the scalpel goes into the shoulder joint and hacks away at the adhesions, it is better to let the condition run its full course, which consists of freezing stage, frozen stage, and thawing stage. Of course, one can hasten the onset of the thawing stage with the help of regular exercises.
Stretching exercises are usually the go-to strategy for managing a frozen shoulder. In fact, the Harvard Medical School has published six easy-to-do home exercises for frozen shoulder that can help you reach your ‘thawing goals’ faster. But before you start doing any of these exercises, please check with your doctor and, yes, make sure you warm up your shoulder before commencing any of these exercise routines. The best way to warm up your shoulder is to take one 10-minute warm/hot shower. And while doing the exercises, it’s important to remember not to stretch beyond the point of tension.
Pendulum stretch – Do this once daily. Relax your shoulders. Bend forward as much as possible and let the arm of your affected shoulder hang down. Draw an imaginary circle with the hand about a foot in diameter. Draw 10 circles in each direction. As your symptoms improve, increase the diameter of your circle without straining too much. Once you’re ready for more, hold a light weight in your hand and repeat the exercise.
Towel stretch – Hold one end of a three-foot-long towel behind your back with the hand of your affected shoulder, and grab the opposite end with your other hand. Holding the towel in a vertical position, use your good arm to pull the affected arm upwards to stretch it. Do this simple stretch 10-20 times daily.
Finger walk – Stand three-quarters of an arm’s length away from the wall. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until your elbow is fully stretched and you’ve raised your arm as far as you can, comfortably. Lower the arm slowly and repeat two-three times. Do this exercise 10-20 times a day.
Cross-body reach – You can do this exercise while sitting down or standing. With the help of your good arm, hold the elbow of your affected arm and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the elbow in this position for 15-20 seconds. This simple exercise can be done up to 20 times a day.
Armpit stretch – Lift the frozen shoulder arm onto a shelf about breast-high with the help of your good arm. Bend your knees gently to open up the armpit. Increase the bend ever so slightly to the armpit, and then straighten. With each knee bend, stretch a little further, but don’t overdo it. Do this 10-20 times every day.
Inward rotation – Hook one end of a rubber exercise band around the doorknob of a close door. Standing next to the door, hold the other end with the hand of the affected arm. Now, holding your elbow at a 90-degree angle, pull the band toward your body two-three inches and hold for five seconds. Repeat the routine for around 10-15 times at a stretch.
In addition to the above simple exercises, there are other things one can do to keep the condition from worsening and hasten a quick (or rather, quicker) recovery. On the flip side, the longer one continues to neglect a frozen shoulder, the greater is the risk of developing a permanent shoulder disability. So if you develop shoulder pain, speak to your doctor about frozen shoulder, and start the following measures right away to prevent adhesions from forming.
Hot/cold applications: The question of whether to use a hot fomentation or a cold compress to relieve the pain of a frozen shoulder has been an ongoing debate for a long time. But so far, there is no clear winner. It all depends on what works best for you. So first try warming up the affected shoulder with a heating pad or a hot compress for 15 minutes. If that works for you, great. If not, don’t despair. Cool the affected shoulder with an ice pack for 15 minutes. One of these will definitely give you some relief. Either way, repeat the process several times daily.
Anti-inflammatory medication: Inflammation can trigger a frozen shoulder, or it might even be an integral part of the freezing stage. The simplest way to fight inflammation is to take a natural anti-inflammatory medicine or gently massage the shoulder with an anti-inflammatory balm.
Shoulder support: While a frozen shoulder needs controlled exercise, it also needs adequate rest. Any sudden movements or jerks can slow down the healing process. The best thing to do is wear a sling while not doing your exercises.
Depending on the stage of the frozen shoulder and the severity of pain and stiffness, the treatment will vary. A wide variety of treatments can be used to treat a frozen shoulder, but there is no conclusive evidence of how effective each treatment is and, therefore, which treatment is best. The important thing here is for individual assessment to figure out which treatment is most effective in reducing shoulder pain and increasing range of mobility.
As the first stage of the condition is most painful, the focus should be on relieving the pain. During this stage, its best to limit the range of movements that increase the pain. Also, ask your doctor or learn from online sources how to cure a frozen shoulder naturally, and even how to fix a frozen shoulder naturally.
If painkillers aren’t helping to control the pain, the next step is intra-arthroscopic injections. These injections can help relieve pain and improve the movement in your shoulder. However, they will not cure your condition and your symptoms may gradually return.
One must remember, however, that taking too many injections may damage your shoulder and even reduce the effectiveness of the injections. Try and keep at least three-four weeks between injections.
The initial painful stage is followed by the more prolonged stage of stiffness. This is where exercises come handy. However, if your shoulder is very stiff, exercise may be painful. In which case, a physiotherapist can give your shoulder the correct mobility it needs to heal and become more mobile again.
There are many techniques a physiotherapist has at their disposal to keep the movement and flexibility in your shoulder.
These include:
More recently. there are newer and more sophisticated techniques gaining ground in the treatment and management of a frozen shoulder. Some of them are:
As with exercise, self-evaluation and evaluation with your physiotherapist will ultimately guide you to the best method suitable for you. So it’s extremely critical that you assess the result of each treatment very carefully.
Honestly, surgery should be your absolutely last resort. Because once the scalpel goes into your joint, there is no turning back. So resort to surgery only if your shoulder has not responded to the other treatment options. But please give at least six months of trial for the other options. If it does come down to surgery, there are different types of surgery to choose from:
Whatever you choose, remember, like the injections, surgery is just a quick relief from the pain and not a cure for the problem.
A frozen shoulder can be very frustrating. But the more frustrated you are, the worse it will get. The challenge is to work within the limitations the frozen shoulder allows you and learn to live with it. For example, if the affected shoulder prevents you from playing tennis, golf, squash, or any other sport that requires you to use the affected hand, instead of feeling sorry for yourself, take up some other activity like cycling, walking, or even mentally stimulating games like crossword, Sudoku, etc. And be patient, because if ever there is a condition where ‘time is the best healer’, a frozen shoulder is that condition.
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