Frozen shoulder is the term used to describe a stiff shoulder joint that has temporarily lost the ability to move freely; most people with frozen shoulder have difficulty reaching overhead and reaching to the low back. The stiffening is the body's natural response to inflammation that develops in or near the shoulder. Stiffening is a protective reflex that protects the shoulder from further injury.
In 95 percent of cases, frozen shoulder is totally reversible, although full recovery may take several months. Stretching exercises are the treatments of choice for frozen shoulder.
FROZEN SHOULDER TREATMENT
Limit activity �" During recovery, you should limit overhead positioning, reaching, and lifting. These restrictions can be eased as pain decreases and flexibility increases.
Pain relief �" If needed, a non-prescription pain medication such as acetaminophen (Tylenol), ibuprofen (eg, Advil, Motrin), or naproxen (eg, Aleve) can be taken. (See "Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs)".) No more than 4000 mg of acetaminophen is recommended per day. Anyone with liver disease or who drinks alcohol regularly should speak with his or her healthcare provider before taking acetaminophen.
Ice the joint �" Apply an ice pack or bag of frozen vegetables to the shoulder for 15 minutes every four to six hours to reduce pain and inflammation.
FROZEN SHOULDER STRETCHING EXERCISES
Heat �" Heat helps prepare the tissues for stretching and should be performed prior to exercise sessions. The preferable method of heating is in a warm shower or bath for 10 to 15 minutes. Local heat (for example with a moist heating pad or a towel warmed in a microwave) is an alternative, but generally is not as effective.
Weighted pendulum stretch �" Range-of-motion exercises are recommended early in the recovery period. These exercises are intended to help maintain joint mobility and flexibility of the muscles and tendons in the shoulder. Pain should not exceed mild levels with any range-of-motion/flexibility exercise. Anyone who feels sharp or tearing pain while stretching should stop exercising immediately and consult with a healthcare provider.
The weighted pendulum stretching exercise performs two functions:
Gently stretches the space in which the tendons pass to relieve pressure on the tendons
Prevents the development of a frozen (stiff) shoulder
This exercise can be started almost immediately after a shoulder injury, or after receiving a steroid injection into the shoulder joint. This exercise should be performed after heating for five minutes once or twice per day. The exercise is performed as follows (figure 1):
Relax your shoulder muscles.
While standing or sitting, keep your arm vertical and close to your body (bending over too far may pinch the rotator cuff tendons).
Allow your arm to swing forward to back, then side to side, then in small circles in each direction (no greater than 1 foot in any direction). Only minimal pain should be felt.
Stretch the arm only (without added weight) for three to seven days. Progress this exercise by adding 1 to 2 pounds (0.5 to 1 kg) each week and gradually increasing the diameter of the movements (not to exceed 18 to 24 inches or 45 to 60 cm).
After a few weeks this exercise should be supplemented or replaced by other exercises to target specific areas of tightness/restriction. The pendulum stretch may be recommended as a warm up for more localized flexibility exercises and/or strengthening exercises.
When performed correctly the pendulum exercise should not result in more than mild discomfort. If more pain is felt, consult a healthcare provider for instructions.
Passive stretching exercises �" Passive stretches should be performed after the pendulum stretch exercise. These exercises should further loosen the tightened shoulder lining and restore normal range of motion. These exercises should be performed in sets of 10 to 20 once or twice a day for several months. The goal of these exercises is to stretch the shoulder to the point of tension but not pain. Severe discomfort is unusual and suggests overstretching.
Armpit stretch �" Use your good arm to lift the affected arm onto a shelf, dresser, or any object that is chest high (picture 1). Gently bend at the knees, opening up the armpit. Try to push the affected arm up a little farther with each stretch.
Finger walk �" Face a wall about three-quarters of an arm's length away (picture 2). Using only your fingers (not your shoulder muscles) raise your arm up to shoulder level.
Towel stretch �" Take a 3-foot-long towel, grasp it with both hands, and hold it at a 45 degree angle (picture 3). Use the upper, good arm to pull the arm toward the lower back. This can be repeated with the towel in the horizontal position.
