Frozen Shoulder
What is it?
The shoulder is designed to have a large amount of movement so that we can use our hands/arms in a wide variety of positions. For this reason the the bony part of the joint is small so that it does not block movement. The shoulder joint is mostly made up of a very strong capsule supported by ligaments, muscles and tendons known as the rotator cuff.

The ball at the top of the arm bone (humerus) fits into the very shallow socket (glenoid) which is part of your shoulder blade (scapula). Together they make a ball and socket joint which is surrounded by the capsule which is made of connective soft tissue. 

Frozen shoulder is the shortening, thickening and chronic inflammation of the capsule surrounding the shoulder joint, which can result in pain and loss of motion.
It has been called adhesive capsulitis, and more recently, frozen shoulder contracture syndrome.
Frozen Shoulder
Why does it occur?
Frozen shoulder may be associated with an injury, such as a broken arm, and the inactivity of the arm following the injury. At times, a frozen shoulder may develop with no known cause.  

A primary frozen shoulder is when the exact cause is not known. It is more common in people with diabetes and with a thyroid gland problem. About 15% of patients link it to a minor injury to the shoulder.

A secondary frozen shoulder can develop if the shoulder area is kept still for some time, for example, after a stroke or heart attack. It can also occur after major injury or surgery to the shoulder. 

Frozen Shoulder
What is likely to happen?
There are 3 main phases

Painful phase or "freezing stage" (which can last from 2 to 9 months)
Pain is greater than stiffness. 
The pain often starts gradually and builds up. It may be felt on the outside of the upper arm and can extend down to the elbow and even into the forearm. It can be present at rest and is worse on movements of the arm. Sleep is often affected, as lying on it is painful or impossible. During this time movements of the shoulder begin to be reduced.

Stiff phase or "frozen stage" (which can last from 4 to 12 months)
Stiffness is greater than pain.
The ball and socket joint becomes increasingly stiff, particularly on twisting movements such as trying to put your hand behind your back or head. These movements remain tight even when you try to move the shoulder with your other hand or someone tries to move the shoulder for you. It is the ball and socket joint which is stiff. The shoulder blade is still free to move around the chest wall, and you may become more aware of this movement.

Recovery phase or "thaw stage" (which can last from 5 to 26 months)
Pain has decreased and shoulder range of motion begins to improve.
The pain and stiffness starts to resolve during this phase, and you can begin to use your arm in a more normal way.

The total duration of the process is from 12 to 42 months, on average lasting 30 months.
Frozen Shoulder
Treatment Phase 1
There is no one agreed treatment option that has been shown to work.
Ultimately the shoulder appears to go through the three phases described and no treatment has altered this pattern. The passage of time is the main treatment for phase 1!

Phase 1
During the painful phase the emphasis is on pain-relief such as pain-killing tablets and anti-inflammatory tablets may be prescribed. You can also try using heat, such as a hot water bottle,or cold (ice packs). Injections into the joint may also be offered if the pain continues. Hand Therapy at this stage is directed at pain relief (heat, cold and other pain relieving modalities such as electrotherapy). 

Forcing the joint to move can make it more painful and is best not pursued. You can try using a TENS machine (transcutaneous nerve stimulation) which some people find helpful or try alternative therapies such as acupuncture at Hand Kinetics.
Frozen Shoulder
Treatment Phase 2
Once stiffness is more of a problem than pain, Hand therapy is indicated. You will be shown specific exercises to try and get the ball and socket moving. In addition, the therapist may move the joint for you, trying to regain the normal glides and rolling of the joint. These are known as joint mobilisations. Muscle based movement techniques may also be used.

If movement is not changing with these measures, or if pain is increasing Hand therapy will be discontinued until the joint is ready. It is still appropriate to continue with the suggested exercises at home to try and maintain the movement that you have.
Frozen Shoulder
Treatment Phase 3
Hopefully, as the recovery phase starts you will find that the movement gradually increases. This again can be a useful time to re-introduce Hand therapy to help maximise the movement.

If you have significant pain and stiffness the doctors may offer you a ‘Manipulation under Anaesthetic ’(MUA) plus arthroscopy operation. It involves a distension procedure which tries to stretch the frozen and tight capsule around the shoulder joint.
The tight capsule may be released or removed. In addition the joint is stretched
in certain directions to try and free the joint up. 
Frozen Shoulder
Additional treatment at Hand Kinetics
Frozen shoulder can have a big impact on your ability to continue enjoying the freedom to participate in normal, every day activities or employment for months or years.
Therefore, while you are waiting for the condition to "thaw", it can be hugely beneficial to use some small useful tools to help you to maintain your independence. 

Tools can help you to reach difficult areas such as brushing your hair, sponging your feet or turning a key and can improve your quality of life until your shoulder regains movement.

At Hand Kinetics you can expect all stages of healing to be addressed appropriately. This includes an assessment to see which assistive tools can help you and which incremental exercises you can perform at home to make sure your frozen shoulder heals in the earliest time-frame it can.

Please talk to our principal therapist at Hand Kinetics to discuss your specific needs and shoulder problem before making an appointment and we will be happy to discuss treatment options with you.

Hand Kinetics Telephone: 0044 28 417 72301

15 The Avenue, Burren, Warrenpoint. Co. Down. BT34 3XJ

0044 28 4176 7238
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