Most of us don't think twice about taking a book off an overhead
shelf, reaching an arm back to put on a coat, or rolling a bowling ball. But if
you have a frozen shoulder (also called adhesive capsulitis), these simple
movements can be painful and nearly impossible. Frozen shoulder is the
temporary loss of normal range of motion in the shoulder. It tends to get
worse, and can lead to considerable disability. The condition typically affects
adults over age 40, and women more often than men.
Experts don't fully understand what causes frozen shoulder. An
inflammatory process is probably involved. Often a shoulder freezes up because
it hasn't been used for a while because of pain, injury, surgery, or illness.
In most cases, a frozen shoulder can be unfrozen, although full
recovery may take months and a lot of self-help.
Anatomy of the shoulder joint
The shoulder joint has a wider and more varied range of motion
than any other joint in the body. It's made up of three bones — the clavicle
(collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).
The main joint is a ball-and-socket arrangement called the
glenohumeral joint, which joins the top of the upper arm bone to a scooped-out
part of the shoulder blade called the glenoid cavity.
The glenohumeral joint lets the shoulder move forward and
backward and lets the arm rotate and extend outward from the body. A flexible
capsule filled with a lubricant called synovial fluid protects the joint and
helps keep it moving smoothly. The capsule is surrounded by ligaments that
connect bones to bones, tendons that fasten muscles to bones, and fluid-filled
sacs called bursae that cushion tendons and bones during motion.
This elaborate architecture of soft tissues accounts for the
shoulder's marvelous flexibility, but also makes it vulnerable to trauma and
chronic wear and tear.
What causes frozen shoulder?
A frozen shoulder develops in stages. The process usually begins
with injury or inflammation of the soft tissues of the shoulder. With
inflammation comes pain that is worse with movement, which limits the ability
to use the joint in its full range of motion.
When the shoulder doesn't move, the capsule surrounding the
glenohumeral joint eventually thickens and contracts, losing its normal
capacity to stretch. The upper arm bone has less space to move around. The
joint may also lose its lubricating synovial fluid. The less the shoulder is
moved to avoid pain, the more likely the capsule will contract. In advanced
cases, bands of scar tissue form between the joint capsule and the head of the
upper arm bone.
A frozen shoulder may take several months to develop. The main
symptoms include:
• pain, often worse at night
• stiffness — even raising the arm may be impossible
• limited range of motion
Who gets frozen shoulder?
People who don't take part in exercise therapy after an injury
or tendinitis are at greatest risk of developing a frozen shoulder. Using a
sling without stretching the shoulder can contribute to the condition. A period
of enforced immobility as a result of a stroke, heart condition, or surgery may
also result in a frozen shoulder. Sometimes the condition occurs without an
obvious injury or inflammation. For example, it affects 10%–20% of people with
diabetes. Other predisposing conditions include thyroid disorders, depression,
and Parkinson's disease.
Diagnosing frozen shoulder
Diagnosis begins with a physical exam to check your shoulder's
range of motion. Your health care provider may ask you to have an x-ray to be
sure there is no other underlying problem, such as osteoarthritis, dislocation,
or a bone fragment, interfering with shoulder motion. An MRI may be needed to
look for a tear in the rotator cuff — the band of muscles and tendons that
stabilizes the shoulder joint.
What to do if you have frozen shoulder
Treatment is focused on relieving pain and restoring your
shoulder's normal range of motion. Your doctor may suggest that you take a
nonsteroidal anti-inflammatory medication such as aspirin, ibuprofen (Advil,
Motrin, generic), or naproxen (Aleve, Naprosyn, generic) to quiet inflammation
and ease pain. Sometimes an injection of a corticosteroid into the shoulder
joint or nearby soft tissues may be needed.
A physical therapist can show you how far to push yourself and
teach you the appropriate exercises. Once you've learned your limitations, you
can do most of the stretching routine on your own at home.
While you're working to stretch the shoulder capsule, try to
avoid any sports or daily activities that increase inflammation or aggravate
your pain. If you diligently follow your shoulder-stretching regimen, you'll
probably be able to return to your usual level of activity. Full recovery may
take several months. If you don't see steady improvement or you reach a plateau,
go back to your clinician or consult a shoulder expert.
A small percentage of people need surgery to
"unfreeze" the shoulder.
http://www.health.harvard.edu/shoulders/frozen-shoulder
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7 stretching & strengthening exercises for a frozen shoulder
Please check with your doctor first:
1. Pendulum stretch
Do this exercise first. Relax your shoulders. Stand and lean over slightly, allowing the affected arm to hang down. Swing the arm in a small circle — about a foot in diameter. Perform 10 revolutions in each direction, once a day. As your symptoms improve, increase the diameter of your swing, but never force it. When you're ready for more, increase the stretch by holding a light weight (three to five pounds) in the swinging arm.
2. Towel stretch
Hold one end of a three-foot-long towel behind your back and grab the opposite end with your other hand. Hold the towel in a horizontal position. Use your good arm to pull the affected arm upward to stretch it. You can also do an advanced version of this exercise with the towel draped over your good shoulder. Hold the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm. Do this 10 to 20 times a day.
3. Finger walk
Face a wall three-quarters of an arm's length away. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until you've raised your arm as far as you comfortably can. Your fingers should be doing the work, not your shoulder muscles. Slowly lower the arm (with the help of the good arm, if necessary) and repeat. Perform this exercise 10 to 20 times a day.
4. Cross-body reach
Sit or stand. Use your good arm to lift your affected arm at the elbow, and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the stretch for 15 to 20 seconds. Do this 10 to 20 times per day.
5. Armpit stretch
Using your good arm, lift the affected arm onto a shelf about breast-high. Gently bend your knees, opening up the armpit. Deepen your knee bend slightly, gently stretching the armpit, and then straighten. With each knee bend, stretch a little further, but don't force it. Do this 10 to 20 times each day.
Starting to strengthen
6. Outward rotation
7. Inward rotation
Stand next to a closed door, and hook one end of a rubber exercise band around the doorknob. Hold the other end with the hand of the affected arm, holding your elbow at a 90-degree angle. Pull the band toward your body two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
http://www.health.harvard.edu/stretching-exercises-frozen-shoulder
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