Most people have heard of frozen shoulder but what exactly is it?
It is a loss of movement in the arm when you are trying to move it yourself (active) or when someone is trying to move it for you (passive).
The movement which is normally lost first is the external rotation (think of your arms down beside you, bent at the elbow so that the forearm is horizontal to the ground and then trying to turn the arms outward away from each other). After this, most other movements become more restricted. Pain is often felt on the outside of the arm where the deltoid muscle attaches to the humorous.
When I was at college, we learnt that frozen shoulder had three phases - freezing, frozen and thawing, each lasting 8 – 12 months. I now think of it as pain predominant phase and then stiffness predominant phase.
During the pain predominant phase, pain is usually worse at night than during the day: it is very difficult to get comfortable. To ease this, use extra pillows and make a hollow for the shoulder.
Exercise is crucial during this phase to decrease pain.
The normal age range for getting frozen shoulder is between 45 and 55, so if you are in your late 60’s or 70’s it probably isn’t frozen shoulder. In Japan it is referred to as “50 year old shoulder!”
I try to suggest to patients that an X-Ray is essential, not because anything will show up if it is true frozen shoulder, but to exclude anything else. The risk of getting a frozen shoulder is increased with:
Previous history of frozen shoulder
Frozen shoulder can occur after trauma i.e. falling on the shoulder, or with over reaching e.g. if you’ve reached behind your seat in a car.
When I treat frozen shoulder, I like to get the patient doing exercises in conjunction with hands on treatment. However, the number one rule is that neither treatment nor exercise should be painful!
When a shoulder joint becomes ‘frozen’ the brain believes the shoulder is really sore and needs to be totally protected. To do this it contracts the muscles around the shoulder joint to stop any movement that will aggravate the joint further, and sets a sensitive pain alarm system on the joint so you don’t move it by accident. Treatment therefore needs to be sneaky – we need to look at ways to gently improve the range of movement without tripping the pain alarm system, over time we can convince the brain that the joint is OK and the pain alarm can be deactivated.