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Everything you need to know about frozen shoulder

What is Frozen Shoulder?

Frozen shoulder is a common condition, affects people between the ages of 40 and 60, and occurs in women more often than men. This is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. It also known as adhesive capsulitis.

Let’s have a look at the Shoulder joint:

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint. To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.

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Stages of Frozen Shoulder:

In frozen shoulder, the shoulder capsule thickens and becomes tight. Stiff bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else. The AAOS describe three stages:

Painful/Freezing /Inflammatory stage

In the “freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

Frozen/Adhesive stage

Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.

Thawing/Regressive stage

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

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Causes of Frozen shoulder:

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Causes of Frozen shoulder:

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes: Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.

Other diseases: Some additional medical problems associated with frozen shoulder include

  • – Inflammatory disease
  • -Hypothyroidism
  • -Hyperthyroidism
  • -Parkinson’s disease and
  • -Cardiac disease.

Immobilization: Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Symptoms:

Pain 

  • – Usually dull or aching
  • – Typically worse early in the course of the disease
  • -The pain is usually located over the outer shoulder area and sometimes the   upper arm
  • – Feel pain lying on the affected side

Movement 

  • – Feel pain when move arm
  • – Joint stiffness
  • – Movement restricted mainly raising hand

Generally frozen shoulder patients complain of this

  • – Unable to do such activities combing hair, back scratching, touch his moneybag in back pocket.

Physical examination: 

After discussing your symptoms and medical history, your doctor will examine your shoulder. Your doctor will move your shoulder carefully in all directions to see if movement is limited and if pain occurs with the motion. The range of motion when someone else moves your shoulder is called “passive range of motion.” Your doctor will compare this to the range of motion you display when you move your shoulder on your own (“active range of motion”). People with frozen shoulder have limited range of motion both actively and passively. The LAM test comes positive.

L- Lateral roation, A- Abduction, M- Medial rotation are painful/stiff .

Imaging Tests:

Other tests that may help your doctor rule out other causes of stiffness and pain include:

X-rays. Dense structures, such as bone, show up clearly on x-rays. X-rays may show other problems in your shoulder, such as arthritis.

Magnetic resonance imaging (MRI) These studies can create better images of problems with soft tissues, such as a torn rotator cuff.

Ultrasound

Management

Physiotherapy intervention: 

Physiotherapy can help you get movement back in your shoulder. Specific  exercises will help restore motion. These may be under the supervision of a physiotherapist. A physiotherapist will decide the number of sessions you need. The exact number depends on how your shoulder responds to treatment.

Treatments from a physiotherapist include:

Therapeutic exercises:

  • -Stretching or range of motion exercises for the shoulder
  • -Strengthening exercise

Manual therapy:

  • Mulligan- Movement with mobilization

Modalities

  • Ultrasound
  • Electrical stimulation
  • -TENS (Transcutaneous electrical nerve stimulation)
  • – IFT (Interferential therapy)
  • Heating pad/IRR

Patient Education

  • Lifestyle modification
  • Pain control

Advice

  • After assessing the condition and during the treatment sessions the Physiotherapist will advice you some specific exercise to do at home according to your condition.

Some examples of exercises are given below which may be helpful for you…..:

External rotation — passive stretch. Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.

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Forward flexion — supine position. Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.

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Crossover arm stretch. Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.

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Pendulum exercise:

Pendulum exercise

Pulley exercise:

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Wall climbing exercise:

Wall climbing exercise

Medical Therapy

  • During the acute “frezzing” phase, NSAIDS and physical therapy are recommended to maintain motion. There is also evidence of short-term benefit from intra-articular corticosteroid injection or oral prednisolone.
  • The use of Non-steroidal Anti-inflammatory Drugs (NSAIDS) may be helpful in patients with relatively new onset symptoms.
  • Individuals who present with prolonged symptoms. Oral corticosteroids can be prescribed in lieu of NSAIDS, as they provide a stronger anti-inflammatory
  • effect.Either NSAIDS or corticosteroids may be used in conjuction with a  subacromial corticosteroid injection.
Physiotherapy Clinic in Dhaka
Dr. Md. Murad Hossain Mehedi

Physiotherapist, Mayfair Wellness Clinic

BPT( DU) NITOR PGD in Exercise physiology (BKSP), MNFS ( Fellow) UniSA Eclectic approach for stroke (India), Comprehensive Rehabilitation Services (PUM Netherlands) Pain, Paralysis, disability and Sports injury Specialist

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2020-10-04T11:22:49+00:00

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