How to treat a frozen shoulder and regain range of motion in your arm
- One of the first signs of a frozen shoulder is a dull, aching pain in the outer shoulder.
- The four stages of a frozen shoulder are prefreezing, freezing, frozen, and thawing.
- Simple stretches and range-of-motion exercises can help reduce pain and stiffness.
Frozen shoulder, also known by the medical term adhesive capsulitis, is a condition where the shoulder joint becomes inflamed, which leads to pain and stiffness. It affects 2% to 5% of the world population and is most common in 40-70 year-olds, especially women.
A frozen shoulder will often heal on its own, says Hascalovici — but if the pain and stiffness persist for more than three months, he recommends seeing your doctor.
Here's what physicians want you to know about identifying a frozen shoulder and treating it at home.
One of the first signs of a frozen shoulder is a dull or aching pain in the outer shoulder area and occasionally upper arm, says Kenneth Donohue, MD, orthopedic shoulder surgeon at Yale Medicine Orthopedics & Rehabilitation.
You may also experience stiffness in the shoulder or have difficulty moving it.
As the condition progresses, additional symptoms usually come on gradually in a series of four stages described below:
During this first stage, you'll start to notice mild to moderate shoulder pain that often gets worse at night. The prefreezing stage typically lasts for one to three months.
The second stage, called the freezing stage, can last anywhere from six weeks to nine months.
Pain and stiffness in the shoulder typically increase, and it often becomes much more difficult to move the shoulder, says Donohue.
This is usually considered the most painful stage, according to Hascalovici, and many patients report that it becomes difficult to sleep through the night due to the pain.
While the pain may be more manageable during this third stage, Hascalovici says the shoulder often becomes more stiff, making it harder to move.
As a result, you may find it difficult to reach overhead or rotate your arm to the side or behind your back, says Donohue. The frozen stage usually lasts two to six months.
The fourth stage is called the thawing stage, which can last anywhere from six to twenty-four months. During this stage, pain decreases and the range of motion improves, according to Donohue.
Although a small percentage of patients may continue to have limitations, Donohue says most will completely recover during this stage.
Note: While most people go through all of these stages in the above order, Hascalovici says everyone's experience with a frozen shoulder is unique — some people may experience a longer frozen or thawing stage, for example.
The shoulder joint is encased in a capsule of connective tissue that helps keep the joint in place, says Donohue. A frozen shoulder occurs when that capsule thickens and tightens, restricting the movement of the joint.
It's unclear why this happens, says Hascalovici, but it seems to occur often in people who haven't been able to use their arms for a while, such as those recovering from an arm injury or surgery.
Some common potential causes of a frozen shoulder include the following:
Immobilization following surgery
A frozen shoulder can develop after someone has had surgery that restricts movement of their arm or shoulder, says Hascalovici. However, you can reduce the chance of getting a frozen shoulder post surgery if you start physical therapy as soon as possible.
In some cases, Hascalovici says your doctor may prescribe corticosteroid shots in the capsule of the shoulder joint to reduce pain and inflammation, thereby allowing you to move the joint more easily so you're less likely to get a frozen shoulder.
A broken or dislocated shoulder, rotator cuff tear, or broken arm are all injuries that can cause a frozen shoulder. That's because you typically aren't able to move your arm for a period of time after these injuries, and immobility or reduced mobility increases your risk of a frozen shoulder.
Exercising regularly to strengthen your bones, as well as taking vitamin D and calcium supplements, can help minimize your risk of these types of injuries, says Hascalovici.
Should you experience a break, dislocation, tear, or fracture, Hascalovici advises immediately seeking medical attention, and stretching your arm as soon and as much as possible once it's safe to do so. Enlist a physical therapist and follow their recommended exercises.
People with diabetes are five times more likely to experience frozen shoulder than people who don't have this disease.
Researchers are still studying the reason for this link. However, Hascalovici says it may have to do with the fact that when you have chronically high blood sugar, those extra glucose molecules attach to collagen — a major building block of the connective tissue in your shoulder joint. When that happens, it can cause the tissue to become inflamed thus making you more prone to a frozen shoulder.
Working with your doctor to keep your blood sugar levels under control as much as possible, as well as regularly exercising and stretching your shoulders, can reduce your risk of a frozen shoulder.
Sometimes, a stroke causes arm paralysis — and being unable to move your arm for an extended period of time can eventually lead to a frozen shoulder.
Hascalovici recommends regularly moving your shoulder through its full range of motion as soon as you are able. In cases of persistent discomfort, your healthcare provider may recommend transcutaneous electrical nerve stimulation or steroid injections to help with pain and inflammation.
Note: Frozen shoulder is also associated with cardiac disease, Parkinson's Disease, and thyroid disease.
Exercises and treatment
Frozen shoulder symptoms will typically diminish with exercise and physical therapy.
Stick to simple stretches and range-of-motion exercises, which you can do at home. Remember that you will probably feel some pain while doing these.
"Our instinct is not to move joints that hurt, but this is the opposite of what you should do with a frozen shoulder," says Donohue. "I recommend starting shoulder stretching exercises as early as possible. Over-the-counter anti-inflammatory medications, like ibuprofen and aspirin, can also be very helpful for patients who are able to take them."
Note: If your range of motion doesn't improve within three to six months of trying home exercises and physical therapy, talk to your doctor about corticosteroid injections or surgery. Moreover, if pain and stiffness persist after a few weeks of treatment, it wouldn't hurt to check in with a doctor to rule out any other serious issue.
Below are some exercises that Donohue and Hascalvoci recommend for a frozen shoulder that may help to restore movement. Donohue advises doing 20 repetitions of these exercises daily.
- Assisted elevation: Start by lying flat on your back on a bed or floor with your hands resting on either side. Then reach over and grasp the wrist of your affected arm with your opposite hand. Keeping your affected arm straight without locking your elbow, pull it toward the ceiling with your unaffected arm and then overhead until you feel a gentle stretch. Hold for 10 seconds.
- Assisted rotation: Lie flat on your back on a bed or floor, holding a stick slightly wider than your shoulders with both hands. With your elbows bent at a 90-degree angle, and knuckles facing toward the ceiling, slowly move the stick toward the affected arm while keeping the elbows close to the body. Hold for 10-15 seconds.
- Crossover arm stretch: While standing upright, use your unaffected arm to gently pull the affected arm straight across your chest as far as possible without discomfort. Hold for 10 seconds.
- Finger walk: While facing a wall that's slightly closer than arm's length away, reach out with the affected arm and touch the wall at waist level. Keep your elbow slightly bent as you gradually walk your fingertips up the wall until you've raised your arm as far as you can. Slowly lower your arm and repeat.
- Pendulum stretch: While standing with your shoulders relaxed and arms hanging at your sides, lean over slightly and start swinging the affected arm in a small forward circle, then reverse directions and swing in a backward circle. Do 10 circles in each direction. As your range of motion improves, gradually begin doing this exercise in larger circles.
Note: If you're treating a frozen shoulder, it's important to warm up your shoulder muscles and joints before doing any exercises — this increases blood flow to the area, thus enhancing your flexibility and allowing you to move through the full range of motion. Prepare your body for these stretches by applying a heating pad, or taking a 10-15 minute warm shower or bath.
A frozen shoulder is a condition caused when the capsule of connective tissue surrounding the shoulder joint becomes inflamed, thickening and tightening as a result.
It's most common in women above the age of 40, as well as people recovering from a recent shoulder injury or who have a history of diabetes or stroke.
Symptoms — which include dull or aching pain, stiffness, and restricted range of motion — typically develop in a series of four stages. If the symptoms don't improve within three months, experts advise seeing your doctor.
The best way to treat a frozen shoulder is to perform daily stretches and exercises that can improve mobility, and take over-the-counter anti-inflammatory medications to help with the pain. If those strategies aren't working, your doctor may recommend steroid injections or surgery as a last resort.
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