A “frozen shoulder” is a term describing the loss of movement in the shoulder joint which is commonly associated with pain in the shoulder and upper arm. The patient usually presents with pain on moving the arm in particular reaching up and reaching behind the back. Often the patient is unable to sleep on the affected side.
What causes a frozen shoulder?
A frozen shoulder may develop following a fracture of the humerus ( upper arm bone ) as the arm will have to be immobilised in a sling to allow the fracture to heal. However in many cases of frozen shoulder there is no history of injury. Sometimes the patient may recall a sudden pull on the shoulder as in lifting a heavy case and then noticing a pain in the arm a few days later. One theory is that a minor trauma to the shoulder joint can trigger an inflammatory reaction in the joint leading to pain and loss of movement. The shoulder joint normally has a very loose soft stretchy lining called the capsule. When a frozen shoulder, also known as “ adhesive capsulitis”, develops the capsule becomes hard and leathery and so movement becomes restricted and painful.
How do we treat a frozen shoulder?
If the patient is in constant pain and has very little movement in the shoulder the patient’s doctor may prescribe a course of anti-inflammatory medication and the patient may be able to do some gentle exercises. If the pain is severe the doctor may refer the patient to an orthopaedic specialist for a steroid injection into the shoulder joint. In cases where the pain is more related to movement of the arm physiotherapy treatment is indicated. The physiotherapist will assess the patient and start them on a programme of exercises to stretch and strengthen the shoulder. The physiotherapist will use mobilisation techniques directly on the shoulder to help restore movement to the joint. The patient will be given a home exercise programme which needs to be performed twice daily. Depending on the severity of the condition the patient should start to see an improvement within a couple of weeks. An example of the exercises commonly prescribed is given below.
Frozen shoulder exercises
- Stand beside a kitchen chair. Hold the back of the chair with your good hand. Lean forward and let the affected arm dangle toward the floor. Start to swing the arm forward and back like the pendulum of a clock. Increase the length of the swing as able. Repeat up to 20 times. Now swing the arm in a circular motion first going clockwise x 10 and then anticlockwise x 10. Finally swing the arm across the body and then out to the side up to 20 times.
- Lie on your back, arms close to body. Bend elbows to 90 degrees palms facing in. Place the end of a rolling pin in the palm of the affected side and start pushing the hand out from the body with the good arm. Stop at the point of pain and hold x 15 seconds. Release. Repeat x 5
- Still lying on your back hold the wrist of the affected hand with your good hand. Raise the hands above your head to the point of pain. Hold 15 seconds. Come back halfway and repeat x 5.
- Standing, hold the rolling pin behind the back bringing the hands as close as possible. Bend your elbows to slide the rolling pin up the back and then down, Repeat x 10.
