Frozen Shoulder

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.

But the cornerstone of treatment is physical therapy, concentrating on exercises that stretch the joint capsule (see Stretching exercises for a frozen shoulder). Muscle strengthening comes later.

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:

Frozen shoulder (also known as adhesive capsulitis) is a condition in which the shoulder is stiff, painful, and has limited motion in all directions.

Stretching exercises are usually the cornerstone of treating frozen shoulder.

Always warm up your shoulder before performing your exercises. The best way to do that is to take a warm shower or bath for 10 to 15 minutes. You can also use a moist heating pad or damp towel heated in the microwave, but it may not be as effective.

In performing the following exercises, stretch to the point of tension but not pain.

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

As your range of motion improves, add rotator cuff–strengthening exercises. Be sure to warm up your shoulder and do your stretching exercises before you perform strengthening exercises.

6. Outward rotation

Hold a rubber exercise band between your hands with your elbows at a 90-degree angle close to your sides. Rotate the lower part of the affected arm outward two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.

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