Frozen Shoulder. Causes? There are two main types of frozen shoulder. Primary frozen shoulder is when the exact cause is not known.

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1 Frozen Shoulder. What is frozen shoulder Frozen shoulder is when the shoulder becomes stiff and painful, often for no apparent reason. It can mean that you have difficulty doing your usual daily activities. Frozen Shoulder occurs when the capsule surrounding the joint becomes inflamed, making it appear to tighten and shrink. It is this that causes the restriction in movement and the pain. Frozen shoulder can last between 6 months and 3 years. On average it lasts about 18 months, the length depending on the severity. Symptoms Your shoulder will gradually become painful and stiff. This will make it difficult for you to bring your hand out to the side, behind your head and behind your back. The pain will be dull or aching and will be around the outside of your shoulder or upper arm. About the shoulder. The shoulder is an important joint in the upper body as it is designed to have a large amount of movement so that we can use our arms and hands in a variety of positions. Some movement around the shoulder comes from the shoulder blade and the chest wall, but the majority comes from the ball and socket (glenohumeral) joint. The ball part is the top of the arm bone (humerus) and the socket is part of your shoulder blade (scapula). There is a loose bag like capsule that surrounds the joint, which is supported by ligaments and muscles. Causes? There are two main types of frozen shoulder. Primary frozen shoulder is when the exact cause is not known.

2 Secondary frozen shoulder develops from the shoulder area being kept still for a prolonged period of time, for example after a stroke, heart attack or long hospital stay. It can also occur from a major injury or surgery to the shoulder. Occurrence? It is known that frozen shoulder is more common in people aged and it is estimated that it will affect 1 person in every 50 each year. It is more common in people with diabetes or with a thyroid gland problem. Although it is common, it can be difficult to treat. It is important to note that although the pain and stiffness may be severe, usually the problem will resolve and it will not be a problem forever. About 10% of people may develop frozen shoulder in the other shoulder within 5-7 years of the first one, although it does tend to resolve more quickly. Diagnosis Frozen shoulder is usually diagnosed by you telling your GP or physiotherapist a detailed history of your symptoms and from a physical examination of the movements of your shoulder. X-Rays or other scans may be done to rule out other shoulder problems. Phases There are 3 phases that a frozen shoulder will pass through. Stage 1: Freezing phase. (Lasting 2-9 months). Pain will start gradually and build up. You may feel the pain on the outside of your arm and sometimes down to your elbow or even your forearm. The pain will get worse as you gradually lose movement in the shoulder. Pain can be present at rest and will get worse with movement. Your sleep may also be affected as lying on it will be painful. Try lying with a pillow under the armpit of the affected shoulder to reduce pain at night. Treatment at this stage: the emphasis of treatment at this stage is pain relief. You may be prescribed painkillers or anti-inflammatory tablets. Heat is very effective at this stage for pain relief as well as cold therapy such as ice packs. If the pain is severe your GP may suggest an injection into the shoulder to relieve some pain short-term. This is individual to each patient. At this stage physiotherapy is also directed at pain relief involving heat or cold therapy. In some cases acupuncture or TENS may be beneficial to some patients, however there is no clinical research showing that these are effective. Forcing the joint at this point will only make it more painful. You can help during this phase by avoiding activities that make the pain worse such as bringing your hand above your head or behind your back to reduce the irritation in your shoulder. Maintaining good posture is also useful. Stage 2: Frozen phase. (Lasting 4-12 months). This is when the ball and socket joint becomes more stiff, especially when twisting the shoulder e.g. putting your hand behind your back or behind your head. They can remain

3 stiff even when someone is moving your arm for you. The pain will sometimes settle at this stage, although stiffness remains. Treatment at this stage: physiotherapy is often indicated at this stage when the main problem is stiffness. You will be shown exercises which aim to maintain the movement of your shoulder. It is important to note that these exercises will help maintain the range of movement to help you carry out daily activities but the stiffness will return the next day, so they will need to be carried out daily. In addition to doing exercises your physiotherapist may move the joint for you to help regain normal glides within the joint. Stage 3: Thawing phase. (Lasting 5-26 months). The pain and stiffness wil start to resolve at this stage and you will begin to regain some of the movement you have lost and use your arm in a more functional way. Treatment at this stage: physiotherapy is again beneficial at this stage to help maximise your regaining of normal movement. The best treatment for frozen shoulder is time. Although it has been shown that there are some thing that can be done to help frozen shoulders, it has been shown that there are 3 definitive stages and no treatment will alter this pattern. Other treatment options For those that take longer to resolve, usually longer than months, your GP may refer you to an orthopaedic consultant. They may decide to perform a Manipulation under Anaesthetic or capsular release operation. The aim of these is to stretch or loosen the capsule of the joint which is tight. This is not routinely offered for frozen shoulder, it is only considered in those which are slow to resolve.

4 Exercises These are a few exercises you can begin to do to stretch the capsule of your shoulder. If you see a physiotherapist they may change them for your particular shoulder. Do these exercises regularly up to 3 times a day. You might find them easier after a hot shower or bath or after using a hot pack/ hot water bottle on the affected shoulder. It is normal for you to feel an aching or stretching sensation whilst doing the exercises. You may feel some discomfort but do not force into pain. The first movement to return will be bringing the arm forwards. Getting your hand behind your back is usually the last. Pendulum Lean forwards with support. Let your affected arm hang down. Swing your arm; forwards and backwards, side to side, in circles (both ways). Repeat up to 10 times. Arm above head. Lie down on your back. Support your affected arm with the other hand at the wrist. Do not let your back arch. Lift your arm up overhead. Bring your arm back to the starting position slowly. To make this exercise easier, have your elbows bent. Arms outwards. Lying on your back, have your knees bent and feet flat. Place your hands behind your neck or head with your elbows up to the ceiling. Let your elbows fall outwards.

5 Kneeling on all fours. Start by kneeling on all fours. Keep your hands still and gently sit back towards your heels. To progress, take your knees further away from your hands. Sideways pulley. Start by sitting or standing, facing forwards. Try and set up a pulley system with the pulley high above you. Pull down with your better arm to help lift your stiff arm. Twisting outwards. Sit or lie holding a stick (e.g. a rolling pin or umbrella). Keep your elbows into your side throughout. Push with your unaffected arm so the affected side moves outwards.

6 Stretching the back of the shoulder. Take your affected shoulder across your body, using your other arm for support. Give a gentle stretch by pulling it at the elbow. Hold for up to 20 seconds. Hand behind back. Stand with your arms side by side. Hold the wrist of your problem arm and gently pull towards the unaffected side and then gently slide your arm up your back. You can progress this by using a towel over your shoulder and grasping with the unaffected hand above the shoulder and the affected hand behind the back, gently pulling upwards.

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