Introduction
Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the shoulder joint, causing pain and stiffness that progressively worsens over time. Understanding its symptoms, assessment methods, and treatment options can help individuals manage and recover effectively. In this comprehensive guide, we will explore the symptoms, diagnostic steps, and a detailed customized treatment plan for frozen shoulder.
Understanding Frozen Shoulder
Frozen shoulder occurs when the shoulder capsule thickens and tightens, leading to restricted movement. The exact cause is unknown, but it is commonly associated with:
- Prolonged Immobilization (post-surgery, injury)
- Diabetes & Metabolic Disorders
- Autoimmune Diseases
- Thyroid Dysfunction
- Aging & Gender (More Common in Women Above 40)
Symptoms of Frozen Shoulder
1. Pain
- Gradual onset of dull or aching pain in the shoulder
- Increased pain at night, affecting sleep
- Difficulty performing overhead activities
2. Stiffness
- Loss of active and passive shoulder range of motion (ROM)
- Difficulty reaching behind the back or lifting arms above head
- Stiffness gradually increases over weeks to months
3. Weakness
- Muscular weakness due to restricted movement
- Difficulty carrying objects or performing daily activities
- Possible muscle atrophy in prolonged cases
Phases of Frozen Shoulder
- Freezing Stage (Painful Stage) (2-9 Months)
- Gradual onset of shoulder pain
- Increasing stiffness
- Sharp pain with movement
- Frozen Stage (Stiff Stage) (4-12 Months)
- Decreased pain but increased stiffness
- Limited ROM, difficulty performing tasks
- Shoulder joint becomes rigid
- Thawing Stage (Recovery Stage) (6 Months – 2 Years)
- Slow return of movement
- Pain diminishes
- Shoulder regains function gradually
Assessment & Diagnosis
1. Patient History
- Duration and onset of pain
- Past injuries or surgeries
- Underlying medical conditions
2. Physical Examination
- Active and Passive Range of Motion (ROM) Tests
- Painful Arc Test (pain at 60-120 degrees)
- External and Internal Rotation Limitation
3. Imaging Tests
- X-ray: Rules out fractures or arthritis
- MRI or Ultrasound: Detects soft tissue inflammation
Personalized Treatment Plan
Stage 1: Pain Management & Early Mobility (Freezing Stage)
- Pain Control: NSAIDs, heat therapy, and cold packs
- Stretching Exercises: Gentle pendulum exercises
- Physical Therapy: Passive joint mobilization
- Hydrotherapy: Warm water exercises to ease stiffness
Stage 2: Restoring Mobility (Frozen Stage)
- Joint Mobilization: Gradual stretching techniques
- Isometric Strengthening: Resistance bands for shoulder muscles
- Massage Therapy: Soft tissue mobilization
- Postural Correction: Ergonomic adjustments to reduce strain
Stage 3: Strengthening & Recovery (Thawing Stage)
- Advanced Strength Training: Dumbbell and resistance exercises
- Functional Movement Training: Activities mimicking daily tasks
- Manual Therapy: Deep tissue massage & joint manipulation
- Progressive Load Training: Gradual return to full activity
Step-by-Step Frozen Shoulder Exercises
1. Heat and Cold Therapy
- Apply a warm compress or heating pad for 15-20 minutes before exercises to loosen the muscles.
- Use an ice pack after exercises to reduce inflammation and pain.
2. Gentle Stretching Exercises
Pendulum Stretch
- Lean forward, let your arm hang freely.
- Gently swing your arm in small circles.
- Perform 10 reps in each direction.
Towel Stretch
- Hold a towel behind your back with both hands.
- Use your good arm to pull the affected arm upward.
- Hold for 15-30 seconds, repeat 5 times.
Cross-Body Shoulder Stretch
- Bring the affected arm across your chest.
- Hold the elbow with the opposite hand.
- Hold for 30 seconds, repeat 3-5 times.
Wall Walk Exercise
- Stand facing a wall.
- Use fingers to walk up the wall slowly.
- Hold for a few seconds, repeat 10 times.
External Rotation with Resistance Band
- Hold a resistance band with both hands.
- Rotate outward while keeping elbows tucked.
- Perform 10-15 repetitions.
3. Self-Massage Techniques
- Use a tennis ball or foam roller to massage the shoulder area.
- Apply gentle pressure to tight muscles to release tension.
4. Posture Correction
- Maintain proper sitting posture to avoid unnecessary strain.
- Avoid slouching and ensure your workstation is ergonomic.
5. Pain Management
- Over-the-counter NSAIDs (Ibuprofen, Naproxen) can help relieve pain.
- Try topical pain relief creams for localized relief.
6. Rest and Activity Modification
- Avoid heavy lifting and overhead movements.
- Perform daily gentle stretches to maintain flexibility.
- Take frequent breaks if engaging in prolonged activities.
Medical Interventions
1. Corticosteroid Injections
- Reduces inflammation and pain
- Short-term relief, best for severe cases
2. Hydrodilatation (Shoulder Joint Injection)
- Expands joint capsule with fluid injection
- Improves movement and reduces stiffness
3. Surgical Intervention (Last Resort)
- Arthroscopic Capsular Release (removing tight tissue)
- Manipulation Under Anesthesia (forcefully moving the shoulder)
Prevention & Long-Term Management
- Maintain shoulder mobility with regular exercises
- Avoid prolonged immobilization after injury
- Maintain good posture while working
- Engage in daily stretching routines
Conclusion
Frozen shoulder can be challenging, but with proper diagnosis, a structured treatment plan, and dedicated rehabilitation, full recovery is possible. If symptoms persist, consult a healthcare professional to explore additional treatment options.