Frozen shoulder and Physiotherapy management

 What are frozen shoulders?

Frozen shoulder, also known as adhesive capsulitis, is defined as a painful restriction of both active and passive movement of the shoulder joint.

On this page......

• What are frozen shoulders?
• Symptoms of a frozen shoulder
• Diagnosis of a frozen shoulder
• Physiotherapy management of frozen shoulders
• Home advice for frozen shoulders
• Electrical therapy for a frozen shoulder
• Medication for a frozen shoulder

Causes of frozen shoulders: 

• Age: Frozen shoulder most commonly affects the ages of 40 and 60 years old.
• Sex
• Previous or recent shoulder injury
• Diabetes: Between 10% and 20% of people with diabetes develop frozen shoulders.
• Health diseases and conditions: for example, stroke, Parkinson’s disease, and heart disease.

Symptoms of a frozen shoulder

There are three classical stages of a frozen shoulder:

1. Stage I: Pain is intermittent; pain is present above the elbow joint; the patient can sleep on the affected side; and there is a minor capsular pattern.

2. Stage II: Pain is constant, pain radiates below the elbow, the patient can't sleep on the affected side, and the patient has a full capsular pattern.

3. Stage III: The patient might demonstrate similar symptoms as stage I, but the prominent feature is the restriction of shoulder ROM.

Diagnosis of a frozen shoulder

physical exam,

A healthcare provider might ask you to move your arm in certain ways. This is to check for pain and see how far you can move your arm (active range of motion). Then you might be asked to relax your muscles while the provider moves your arm (passive range of motion). Frozen shoulders affect both active and passive ranges of motion.

 imaging tests

A frozen shoulder can usually be diagnosed from signs and symptoms alone. But imaging tests—such as X-rays or MRIs—can find problems.

Physiotherapy management of frozen shoulders

• In stage I, a pain-free range of motion is allowed.
• In stage II, the maximum available range is permitted.
• Either superficial or deep heating agents control pain.
• Stretching exercises for capsules.
• Passive mobilization of the shoulder joint.
• Strengthening exercises for shoulder muscles: isometric, isotonic, 

Home advice for frozen shoulders

1. Pendulum stretch. Keep your shoulders loose and your arms by your sides as you stand. Lean forward a little, letting your afflicted arm droop. If necessary, you can use a table to support your good arm's hand. Ten times in one direction, then ten times in the opposite direction, swing your dangling arm in a circle with a diameter of about a foot. Enlarge the circles as your mobility improves and your pain subsides. You can perform the exercises using a lightweight—no more than three to five pounds—as your symptoms get better.

2. wall climbing exercise: face a wall, standing so your fingers can just touch it. Keeping your shoulder down (don't shrug up toward your ear), walk the fingers of your injured arm up the wall as high as pain permits. Hold that position for at least 15 to 30 seconds. Slowly walk your fingers back down to the starting position.

3. Cross-body reach. Put your good arm's hand on your bad arm's elbow. Raise the bad arm over your chest and up until you feel the shoulder extending. For 15 to 20 seconds, hold. Ten to twenty times a day, repeat. 

   
   
   

4. Towel stretch. Position yourself such that your afflicted arm is holding the bottom edge and your good arm is holding the top edge of a 3-foot-long towel that is held vertically behind your back. Raise your unaffected rear arm gradually until you feel a strain in your shoulder. Hold for 10 seconds. Do it five times, twice a day, for five days.

   
   
   

5. Outward rotation. Stand with your upper arms against your sides and your elbows bent at a 90-degree angle. Hold each end of a rubber exercise band in each hand. Keeping your good arm still, gently pull the affected arm out to your side, about 2–3 inches. Hold for 5 seconds. Repeat 10-15 times daily. 

   
   
   

6. Inward rotation. Stand next to a closed door. Loop one end of an exercise band around the doorknob and hold the other end in the hand of your affected arm. With your elbow at a 90-degree angle and your upper arm by your side, pull the band toward your body about 2–3 inches. Hold for 5 seconds, and repeat 10-15 times daily.

7. Sleep with proper head and neck support. Whether you’re a back sleeper or a side sleeper, you need a pillow that keeps your head and neck in line with your spine. For side sleepers, this means a thicker pillow to lift your head. Back sleepers need a slightly lower loft, while belly sleepers need a relatively flat pillow.

8. Sleep with extra pillows. The best sleeping position for a frozen shoulder is on your unaffected side with an extra pillow between your arms. This helps open your chest and keeps your shoulders aligned. If you don’t have a body pillow, put a smaller pillow in your armpit and hug it to avoid curling your shoulders inward. A pillow between your knees can help keep your hips and spine aligned and keep you from curling inward.

9. Sleep with your arms by your side. If you’re more comfortable sleeping on your back, rest your arms by your sides with your palms facing your mattress. This position puts the least amount of pressure on your shoulder joints and provides a gentle stretch to your shoulder muscles.

   
   
   

10. Pully exercise: This exercise can be done in a seated position. Place the pulleys between your fingers after grabbing them. Raise your arm independently, or assist in lowering it with your other arm. Maintain a straight elbow position and downcast shoulders. For roughly ten seconds, hold.

    
    
    

Electrical therapy for a frozen shoulder

Ultrasound Therapy (UST): frequency range of 0.75–3 MHz apply duration, one time a day, for 5 to 10 minutes.

Hot or Cold Water Pack: Hot and cold therapy involves the application of heat or cold to the affected area. Heat therapy can help to increase blood flow and relax muscles, while cold therapy can help to reduce inflammation and numbness. Both hot and cold therapy can be beneficial for managing the symptoms of frozen shoulders.

Medication for a frozen shoulder

• Pain relief: Avoid movements that cause you pain. Only move your shoulder gently. Use paracetamol or ibuprofen to ease the pain.
• Stronger pain and swelling relief—prescribed painkillers. Maybe steroid injections in your shoulder will bring down the swelling.