What is frozen shoulder: 3 Stage & Physiotherapy to Ease Pain

Frozen shoulder is a very painful shoulder condition that makes it difficult for you to comb your hairs, doing undo clothes. One of the main complaints is night shoulder pain. It is also termed peri-arthritis shoulder and adhesive capsulitis which commonly affects females more than males.

In this article, we will try to understand what is frozen shoulder is, why does it happen and how your physiotherapist can help you.

What is frozen shoulder

Frozen shoulder is a clinical syndrome characterized by pain and gross restriction of shoulder movement and which is associated with contraction & thickening of the joint capsule. The sufferer usually describes constant pain that remains the whole day long, as an “electric current” type of painful feeling when trying to move the shoulder or when something hits on it.

Shoulder stiffness is a common complaint that results in unbearable pain during putting on and off clothes or reaching the back pocket. But, what actually causes frozen shoulder

Causes of periarthritis shoulder

Frozen shoulder can be due to the primary or secondary cause. Primary idiopathic frozen shoulder is often associated with other diseases and conditions, such as diabetes mellitus, and maybe the first presentation of a diabetic patient(1). Patients with systemic diseases such as thyroid diseases(4,5) and Parkinson’s disease(6) are at higher risk.

Secondary adhesive capsulitis can occur after shoulder injuries or immobilisation after the fracture around the shoulder joint (e.g. clavicle fracture, rotator cuff injury, shaft of humerus fracture). These patients develop pain from the shoulder pathology, leading to reduced movement in that shoulder and thus developing frozen shoulder¹.

There are various contributing factors but the exact cause is still unknown, but it commonly affects females more than males. common in the middle and elderly age group. The contributing factors could be:

1. Pain– Because of pain, the shoulder remains in the immobilized position which gives rise to adhesion formation in the capsule of the shoulder joint.
2. Immobilisation– In some cases, the condition is initiated by a period of immobilization; eg- prolonged use of shoulder sling after Colle’s fracture.
3. Posture– Wrong posture like kyphotic, head forward, rounded shoulder.
4. Occur more in female particularly postmenopausal women.
5. Diabetics are found to be more prone to it.

What goes wrong in your shoulder

Every joint has a capsule (outer covering) around it. As you can see in the figure, the shoulder joint also has a capsule around it and in the frozen shoulder this capsule dries up.

Capsule dries up, get shrunk and get adhere to the joint and its surrounding structure. This makes the shoulder stiff and produces a great deal of pain when one tries to elevate the shoulder. With time due to lack of shoulder movement, due to pain, the muscles surrounding the shoulder starts to become weak.

Symptoms & 3 stages of perarthritis shoulder

Frozen shoulder is a very painful condition, usual complaint of the patient is:

• Pain with activities.
• Pain during the night.
• Unable to do the overhead activity such as combing, wearing t-shirts due pain and restriction of the shoulder.
• Unable to reach back pocket.
• Weakness in hand.
• Electric shock like pain in hand if shoulder gets hit by something.
• unable to lift the object.

3 Stages of frozen shoulder

Frozen shoulder occurs in three phases: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting.

Stage 1: Freezing Phase

Pain is often most severe during the freezing phase. This phase can last for 2-9 months¹.

1. Characterised by pain on outer side of the upper arm.
2. Pain is more during the night.
3. The patient can lie on the affected side of the shoulder
4. Complains of pain with activities
5. Restriction of shoulder movement begins at this stage.

Stage 2: Frozen Phase

In this phase, severe pain begins to subside but there is a progressive loss of shoulder range of motion. This phase can start in the 4th month and can last up to 12 months.

Stage 3: Thawing Phase

This is the final phase the duration of which is 5 to 26 months. In the thawing phase, the patient experiences a gradual return of range of motion. It is crucial to get the shoulder back to normal as quickly as possible by regaining full movement and strength.

How Physiotherapy can help in frozen shoulder

Your physiotherapist will thoroughly do the physical examination of your affected shoulder. They will measure the ROM (Range Of Motion) of the shoulder. It is the measure of how much the shoulder is moving in every direction or how much the joint is restricted.

Depending on the severity of pain and restriction of movement they will devise treatment plans and exercises for the same. I have described the process of treatment in a very brief manner.    

1) Interferential therapy (IFT)

IFT or interferential therapy It is a modified electrical stimulation given to muscle and nerve. This is very beneficial for the reduction of pain.

2) Ultrasonic therapy (UST)

Ultrasonic therapy has thermal effects and micro-massage effects of ultrasonic rays emitted by Ultrasonic Machine relieve pain and relax the tight muscle and contracted capsule.

3) Mobilization of shoulder

The physiotherapist gently moves the shoulder. It is a special technique that can only be done by a physiotherapist

4) Rope and pulley

Simple rope and pulley arrangements can be done in the home. It can be attached to doors or windows and accordingly used by frozen shoulder sufferers. It is very effective for the flexibility of the shoulder joint.

5) Shoulder Wheel

The shoulder wheel is one of my favourite physiotherapy equipment for frozen shoulders. It is can be found in any good physiotherapy centre. It is very helpful in gaining the range of motion of the stiff shoulder.

What can be done at home

Frozen shoulder sufferer should note that pain in the shoulder and restriction of movement is interlinked. It means that; to reduce pain in the long term, the restriction of movement has to be addressed. This can be done by doing shoulder stiffness exercises regularly. Here is a list of links you can visit for exercises.

• 5 frozen shoulder exercises for quick relief.
• Frozen shoulder stretching exercises.
• 4 Easy Shoulder Wand Exercises for Painful, Stiff Shoulder

Exercises are very important, however, you may sometimes develop pain after the exercise session. This is quite normal and you need not have to worry about it. In addition to this, the injured rotator cuff also needs nourishment. Let me share some important tips and products that can help you with this.

If you have pain, simply apply a pain ointment over the painful area and let the body absorb it for 10 minutes. After a gap of ten minutes apply a hot pack over the area and you would feel almost instant relief. Here are two nutraceutical products I would highly recommend to you. These are natural products prepared from extracts from plants and herbs and do not have any side effects.

FLEXYGEL

This unique gel prepared using nanotechnology works like a wonder. You need to take it twice daily after food. Dosage: Mix one tablespoon of Flexygel with a half glass of warm water and drink it. It is sugar-free, it’s absolutely safe for diabetics.

JOINT FLEX OINTMENT

This highly effective pain balm I would like to recommend to you. I often prescribe this to my patient at my clinic. Get this for yourself now.

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Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.