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by Michelle Sutton-Kerchner
Those who suffer a frozen shoulder know it’s not easily shrugged off. Often, it’s not easily moved at all. Combined with a gripping pain and radiating aches, this condition really gets you in its clutches. Here are tips when you’re ready for a meltdown …
Most never give a thought to their shoulders and all the mechanics involved for their daily functioning. Until one day, for seemingly no explanation at all, they demand attention.
Although lifting a heavy object can trigger low back pain and an overstuffed pillow can kink your neck, the shoulder seems to suddenly protest for no reason. And when it does, don’t even think about a simple act like waving hello or flagging a taxi. A frozen shoulder also makes a lousy bed-partner. Dare to shift your arm the “wrong” way during the night, and it can interrupt sleep for hours with its complaining.
Causes
A frozen shoulder, or adhesive capsulitis, occurs when motion of the shoulder joint becomes restricted. The capsule that surrounds this ball-and-socket joint becomes contracted. Bands of scar tissue, or adhesions, develop and the shoulder doesn’t seem to budge without forcing a wince.
When there is pain with movement, movement decreases. This increases stiffness and, eventually, shoulder movement may become completely impaired. Simultaneously, and not by coincidence, your ibuprofen stash may decrease as well. So much for the joint that usually allows more motion than any other in the body!
Occasionally, this condition is triggered by trauma to the shoulder. (You may consider lightening that 10-pound purse or desk-in-a-bag.) However, most often, there is not a clear cause, only risk factors indicative of predisposition.
Perimenopause: Although a medically defined connection has not been provided yet, frozen shoulder tends to occur between the ages of 40 and 60 years old. About 70 percent of those affected are women. These statistics suggest a correlation between frozen shoulder and a hormonal shift that occurs in the early or pre-stages of menopause.
Shoulder surgery or immobility: When an operation or injury requires joint immobilization, such as through an arm cast or healing process, the shoulder joint becomes susceptible to freezing.
Diabetes and thyroid imbalances: Endocrine issues can affect joints and muscles. Frozen shoulder is reported to occur in 10 to 29 percent of those with diabetes. Sugar adheres to the collagen in cells and affects their functioning. Also, diabetes can damage blood vessels. A poor blood supply may result in scarring of the body’s elastic tissues, which can trigger a frozen shoulder.
Symptoms & Diagnosis
Typically, extensive diagnostic testing is not needed to confirm frozen shoulder. Presentation of symptoms usually is a clear indicator. A physician may wish to eliminate the possibility of a rotator cuff injury through an x-ray, as these symptoms sometimes overlap. An x-ray also reveals arthritic changes or possible injury in the area.
An MRI is occasionally performed with an injection of contrasting fluid in the shoulder joint to help reveal if the shoulder capsule is scarred.
Typical presentation:
- Dull, aching shoulder pain
- Restricted movement and movement accompanied by pain
- Disrupted sleep from stiff and sore shoulder area
- Frustration performing everyday activities, such as shampooing, putting on shirts, putting on and wearing a bra, folding clothes, and keyboarding
Bring on the Thawing Stage
The frozen and most painful stages of this condition can last up to nine months. At that point, the worst symptoms have peaked, most likely along with your tolerance level. This thawing stage can be lengthy, lasting longer than a year. However, with early detection and proper treatment, severity and duration can be reduced.
Treatment
As with many injuries, frozen shoulder responds well to physical therapy treatment. Working with a physical therapist allows stretching of the joint in a controlled environment. According to Ruth Lyons, PT, MPT, getting the joint in motion is essential. It breaks up scar tissue that has formed and reduces stiffness from immobility. Combined with a prescribed exercise program, the frozen shoulder begins to melt and strength returns.
Be prepared. Exercising and stretching a joint that’s been dormant is a slow process that may be accompanied by irritation. The muscles and joint are coming back to life. It’s natural to experience some soreness in this no-pain/no-gain scenario. Start slowly, and gradually increase the swings and weight used in range-of-motion exercises.
Ruth recommends performing the following: circular pendulum, side-to-side pendulum, and horizontal abduction/adduction. As you progress, these exercises become more effective when using two-pound hand weights or wrist weights. Increase to three pounds, when ready.
With radiating pain, you may find the entire rib cage, arm, and hand are troublesome on the affected side. Flexion exercises with a wand (broom, cane, yardstick, or any other stick-like object at hand) provide a good stretch that helps all these areas.
A personal trainer can supplement your time spent in physical therapy. For success, these exercises must be performed three times a day at 20 sets each session, in addition to the techniques utilized in the physical therapy session. With the assistance of a personal trainer, you are assured proper form and maximum efficacy for a quicker recovery process. A trainer can also create a fitness program that incorporates your frozen shoulder to limit muscle atrophy. A bum shoulder shouldn’t derail your overall fitness goals. (For tips on exercising with an injury, see “Go the Extra Mile” at www.fitnessandwellnessnews.com/fitness/go-the-extra-mile.)
Go Hot & Cold
Prior to stretching and exercising, apply moist heat to the shoulder. This loosens and soothes the joint and surrounding muscles. Microwavable heating pads are available in a variety of sizes, some filled with aroma-therapeutic scents. They are an excellent household item, especially for the exerciser. If you don’t have a heating pad available, apply a washcloth soaked in hot water. Leave heat on for 10 minutes prior to beginning your program. When finished, apply an ice pack for the same. Ice will reduce any inflammation that flared during your efforts.
No Quick Fix
A shot of cortisone might sound appealing on days you’re ready to leave your arm behind. Some experience relief from this injection; others don’t notice any improvement. One certainty: To be effective, a cortisone injection should be used in combination with physical therapy and exercise. Its main purpose is to reduce pain for better mobility and stretching during treatment programs.
By adhering to a well-rounded therapy/exercise program– which includes intervals of stretching, exercise, and rest (along with any other modalities your physical therapist and personal trainer deem appropriate)– you can fully recover from a frozen shoulder. Arthroscopic surgery is a last result and rarely performed. Without immediate post-operative rehabilitation, your frozen shoulder could easily return. Best to avoid such last-resorts and work it out!
Sources
“Frozen Shoulder,” at www.mayoclinic.com.
“Frozen Shoulder and Diabetes,” by Gordon Cameron, MD at www.diabetesmonitor.com.
“Frozen Shoulder in Diabetes,” by Paul Schickling, RPh, CDE, and John Walsh, PA, CDE at www.diabetesnet.com.
“Frozen Shoulder Symptoms,” by Jonathan Cluett, MD at www.about.com.
“What Is a Frozen Shoulder?” by Jonathan Cluett, MD at www.about.com.
“What Is the Treatment of a Frozen Shoulder?” by Jonathan Cluett, MD at www.about.com.
Images
Bare shoulder: www.flickr.com/photos/blythe_d/1556876413/
