Freedom from a Frozen Shoulder: It’s Up to You
July 21, 2005
By: Laurie Edwards for Shoulder1
Think that dull ache and loss of shoulder motion usually associated with star baseball pitchers is unique to top-level athletes? You don’t need to be Pedro Martinez to have a problem shoulder; in fact, about 2 percent of the general population has aches, pains and limited mobility caused by what is called frozen shoulder.
| Take Action | Think you might have frozen shoulder?
Consult with your physician, who can use X-rays or MRIs to diagnose the condition.
Don’t ignore pain or injury; often, it is favoring the shoulder or stopping yourself from moving it that can precipitate the development of frozen shoulder.
Consult your doctor before you begin any at-home stretching or exercises. Forcing a motion that the shoulder is not ready for can worsen the condition.
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Most common in women over the age of 40 and in diabetics, frozen shoulder is a condition whose exact causes are not fully understood. It also occurs after a shoulder injury or in people with thyroid, heart or lung problems.
Luckily it’s a problem that is usually easily fixed – with some creativity and hard work on your end in physical therapy, that is. With a combination of exercise, medicine and thermal and ice therapy, more than 90 percent of frozen shoulder patients can avoid surgery and regain total mobility.
The hallmark symptoms of the condition are aching in the outer shoulder, stiffness and an inability to extend to a full range of motion in the shoulder. This occurs because the ligaments surrounding the joint are inflamed. Too often, this initial inflammation sets into effect a cycle of freezing and further irritation.
“When the ligaments are inflamed, the shoulder hurts, when it hurts, you stop moving it, when you stop moving it, it becomes more inflamed [with] more tightness and it’s on this cycle,” explained Beth Israel Medical Center’s Dr. Peter McCann.
The pain of frozen shoulder can last anywhere from weeks to months, and loss of movement can stretch from months to years before normal shoulder functioning is restored.
“At night it was so painful I couldn’t sleep on that side and it would awaken me many times during the night, so I was not getting sleep and it continued to deteriorate over a period if weeks to where I couldn’t really function at all,” said Janie Milstein, echoing the pattern familiar to so many frozen shoulder patients.
Her pain increased during daily activities such as reaching for objects on higher shelves, reaching from the driver’s seat into the backseat of a car, driving and opening heavy doors. Experts caution that working through the pain can actually make the condition worse, so until you work out an exercise regimen with your physician and physical therapist, try creative ways to alter daily functions. Open doors with both arms, hold your steering wheel near the bottom and keep a stool or stepladder handy for when you need to reach objects that are high off the ground.
On the mend
The typical treatment for un-freezing a stubborn shoulder begins with controlling the pain. Most often, anti-inflammatory medications and injections of corticosteroids are the most effective pain reducers. In more extreme cases, nerve blocks can be administered to reduce pain. Heat applied to the shoulder joint can also relieve discomfort, as can ice packs applied at regular intervals.
Once the pain is somewhat diminished, the real work begins: exercising the shoulder with a physical therapist to restore motion. Stretching motions, such as lying down on your back and reaching the arm overhead while applying pressure to the elbow of the extended arm or standing and extending the arm across your torso while applying the same pressure to elbow are a good place to start.
More advanced exercises include using elastic therapeutic bands to increase stretch, using pulleys to extend motion and standing and seated exercises with a therapeutic wand that increases flexibility and motion.
In the small number of cases where exercise does not eventually restore motion, orthopedic surgeons perform an arthroscopic procedure that either divides or cuts the inflamed ligaments, releasing them to allow for more mobility. Most patients regain up to 95 percent of motion within four months.
The trick to avoiding surgery, experts say, is not to wait too long to see a doctor when the pain begins. The sooner exercise and pain control begins, the sooner normal shoulder functioning occurs.
Last updated: 21-Jul-05
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