“I can’t comb my hair.” “I can’t wash my back.” “I have a difficult time putting on my jacket.” “It’s hard for me to tuck my shirt in.” “I can’t reach for things on a high shelf.” These are all very common complaints from people with frozen shoulder. Also known as adhesive capsulitis, frozen shoulder is a condition that results in a tightness of the shoulder reducing its overall movement.
The bones which make up the shoulder joint are held together by a lose capsule of connective tissue. The connective tissue is loose to allow maximal movement of the shoulder, the most mobile joint in the body. With frozen shoulder, this loose connective tissue capsule tightens which restricts the overall movement of the shoulder. Another way to understand frozen shoulder is to look at the construction of the shirt or blouse you are presently wearing. All shirts have extra fabric in the armpit. This extra fabric allows for freedom of movement for the shoulder. Try this: grab the extra fabric under the armpit of your shirt and tightly squeeze it. Now, try to raise your arm over your head. You will notice that you will be unable to raise your hand over your head due to the restriction of the tight fabric. The fabric of the shirt is very similar to the connective tissue of the shoulder. A tightening of the connective tissue will restrict movement of the shoulder.
How does this connective tissue become tight? This is not completely understood. While some conditions are due to trauma, prolonged tendonitis or bursitis, most patients with frozen shoulder will state that “it just happened.” They indicate that they did not fall on it or suffer an injury; however, a gradual loss of movement occurred over the past several months. They do typically indicate that certain movements are painful such as reaching overhead or reaching behind their back. It is known that middle aged women are most prone to this condition and that individuals with diabetes are more commonly affected. Interestingly, right-handed individuals more commonly get frozen shoulder on their left side.
Treatment for frozen shoulder is varied. Most cases require some form of medical intervention. Physical therapy is commonly used to decrease pain, improve strength and range of motion and ultimately function. The physical therapist makes the tight connective tissue more pliable usually with moist heat and ultrasound immediately followed by manually stretching the connective tissue. As the connective tissue is stretched the movement of the shoulder gradually returns. This is a gradual process and treatment may last for several weeks or months. In severe cases, a surgeon will stretch out the connective tissue while the patient is under anesthesia. Following this surgical stretching, the patient is typically sent to physical therapy to maintain the stretch.
As indicated above, most cases of frozen shoulder require medical intervention. If you suspect that you might have frozen shoulder, it is recommended that you see your family physician or orthopedic surgeon and get a referral to a physical therapist.
Movement Is Your Best Friend - If you think you have frozen shoulder, you need to move the shoulder and move it a lot. If you baby the shoulder and protect it from movement the condition will get worse.
Pain Is Your Worst Enemy Yes, move the shoulder as much as you can but do not move it to the point of pain. If you move the shoulder to the point that it is now painful – the frozen shoulder will typically get worse. The bottom line is you want to move the frozen shoulder as much as possible without causing pain.
Warm-Up The Shoulder Before Movement – Use a heating pad, hot shower or bath, or brisk walking to warm up the shoulder before you perform range of motion exercises.
Use a Cold Pack or Ice – after the exercises to control pain and inflammation. Do the exercises 10-15 times each within the limits of pain 3-5 times per day.
Contributions: Gary Mattingly, PT, PhD, Professor, University of Scranton, Department of Physical Therapy, Associate, Mackarey Physical Therapy (deceased).
Read Dr. Mackarey’s Health & Exercise Forum – every Monday – next week: “The Throwing Shoulder”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
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Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.