What is Frozen Shoulder, Causes, Symptoms and Physiotherapy Treatment
What is ankle sprain?
Frozen shoulder also called adhesive capsulitis or shoulder periarthritis is a chronic inflammation of the connective tissue that covers the entire shoulder joint producing pain and stiffness. It affects 2% of the population, with more prevalence between 40-65 years, and affecting more women.
The shoulder joint is an enartrosis, formed by three bones: the humerus, the scapula and the clavicle. The sphere of the humerus is attached to a cavity of the scapula, all wrapped in a connective tissue forming the joint capsule of the shoulder. In this affectation the capsule thickens and hardens, forming adhesions with a lower presence of synovial fluid inside the joint.
Stages or phases in the frozen shoulder
The frozen shoulder has three stages or phases in its evolution not always reaching the same level of adhesive evolution or unfortunately recovery:
Freezing or painful stage : the range of motion begins to decrease and the pain increases. The duration is from 6 to 9 weeks.
Frozen or adhesive phase : in this phase the pain decreases but the stiffness lasts. It becomes very difficult daily life. The duration is usually between 4 or 6 months.
Defrosted or recovery phase : in this phase the stiffness slowly decreases. The complete recovery of movement and strength can last from 6 months to 2 years.
Symptoms of frozen shoulder
Pain: a dull, fixed and continuous pain that occurs more at night and that produces a decrease in arm movements. It occurs more in the first stage.
Rigidity: limiting a lot the movements of the arm as it can be fastening the bra or combing.
Decreased arm mobility: there is decreased mobility of the arm both active and passive.
Causes of frozen shoulder
There is no clear cause that produces frozen shoulder with the use of the arm or the occupation of the person. There are some factors that can produce greater risk:
Diabetes (between 10-20% of people with diabetes are affected by the frozen shoulder but the reason is not known). It is also related to menopause due to a hormonal change, problems with the thyroid and also heart problems. Immobilization from an injury or surgery on the shoulder can develop frozen shoulder. It is convenient that the person moves the shoulder shortly after the injury or surgery as a way of prevention.
Injuries to the cervical can also be a factor in producing frozen shoulder.
Frozen shoulder diagnosis
It is usually done with a good clinical history and a physical examination.
On physical examination the patient is asked to raise the arms with the palms of the hands upwards, arms forward (wanting to push something forward), open the arms to the sides and take the hands behind the back. If any of these movements presents difficulty you should think of frozen shoulder.
Sometimes doctors ask for complementary tests such as an x-ray or an MRI, this is useful to rule out other types of injuries.
The main treatment are non-steroidal anti-inflammatory drugs, steroid injections and physiotherapy. Any risk factor such as diabetes should be treated.
When the treatment is not effective, surgery is performed, shoulder arthroscopy under anesthesia. Physiotherapeutic treatment should be performed always after surgery, recovery varies from 6 weeks to 3 months.
Hot. The heat applied at the beginning of the treatment helps to loosen the shoulder before mobilizations and stretches.
TENS to reduce pain.
Shoulder mobilizations. The physiotherapist should perform gentle mobilizations.
Soft massages of the entire musculature.
Cryotherapy at the end of therapies.
1st Treatment phase
In the first phase it is important to perform a treatment that reduces pain and allows to maintain the range of movement as much as possible. Electrotherapy, cryotherapy, relaxing massage therapy including cervical, passive mobilization and then active pain-sparing and scapular stabilization exercises will be applied.
2nd Phase of the treatment
This phase is where a progressive rigidity is installed. To this, the thermotherapy should be added at the beginning of the session to improve tissue elasticity, pendulum exercises, humeral head release maneuvers looking for distension of the rotator cuffs, contraction-relaxation stretches, stabilization exercises, strengthening of the periarticular muscles. Many other techniques can be used such as Soller, Maitland, manipulations of Mennel, etc.
3rd Phase of the treatment
In this phase we begin with the recovery of mobility. We must give much importance to the muscle rebalancing. Kabat exercises, muscle reeducation exercises, proprioceptive reeducation and muscle re-adaptation will be added.
Prevention is very important, above all there is a history of injuries or traumas with immobilization of the upper extremity. Insisting with abduction, flexion and external rotation.
Exercises for the patient with frozen shoulder
Arañitas: facing a wall with your hands spread over it, climbing with your fingers upwards as if it were a spider, going up to feel a tension in your shoulder, lower and rest your arm, do this 10 times.
Codman exercises: recommended at the beginning of therapy and at the end. Make circles with the arm hanging on the table.
With a stick lying down and sitting perform the movements of flexion, rotation, abduction and adduction of the arm, helping with the healthy arm.
In the frame of a door, place the arm at 90º of flexion and put your hand on the edge of the door, turn the body to cause external rotation in the shoulder.
Self-assist arm lift. Placed in supine on the stretcher to bring the arm upwards and from under the elbow to help with the hand of the healthy arm to force the movement.
Cross the affected arm stretched to the other side passing under the chin and increase the stretch with the hand of the healthy arm. This can be done face up with the help of a towel held at the ends with both hands and pulling to the right or left to seek internal or external rotation.