Overview

Frozen shoulder is a condition that results in loss of movement and/or stiffness of the arm at the shoulder joint. There is usually pain in the shoulder, and it is caused by tightening of the tissues that surround the shoulder joint. In frozen shoulder:

• Active range of motion is lost. This means you cannot move your arm.
• Passive range of motion is lost. This means another person trying to move your arm at the shoulder joint will find it stiff and difficult to move.

Frozen shoulder is progressive, meaning that it gets worse over time. It also may improve spontaneously. This improvement in mobility is called thawing.

Risk factors that increase your chances of developing frozen shoulder include:

• diabetes
• thyroid problems
• disc problems in your neck
• injuries
• illness or injury that forces you to be immobile for a period of time
• tuberculosis
• heart disease and/or lung disease

Diagnosis

Symptoms of a frozen shoulder include:

• painful shoulder
• stiffness in shoulder
• inability to move the arm at shoulder joint, either yourself or by someone else

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will test the range of motion in your shoulder. Tests may include:

• x-rays to rule out other possible causes of the stiffness.
• bone scan
  This is a series of pictures of bones taken after injection of a small amount of radioactive material that highlights the bones.
• arthrograms
  These are x-ray pictures taken after dye is injected into the shoulder area.

Treatment Options

Non-surgical options

Treatment focuses on relieving pain and restoring function and range of motion to the shoulder.

• Pain relievers, such as ibuprofen (Advil, Motrin) and aspirin, may help reduce inflammation and relieve pain.
• Muscle relaxants may help relax arm and shoulder muscles.
• Working with a physical therapist will stretch muscles and restore motion and function to the shoulder.
• Heat and ice therapies may help relieve pain and reduce swelling
• Corticosteroid injections, as prescribed and given by your doctor, may also relieve pain.

Surgical options
Surgery is an option if there is no impro vement after several months. Surgeries include:

• closed manipulation—forceful movement of the arm at the shoulder joint to loosen the stiffness
• arthroscopic surgery—surgery to improve movement at the shoulder joint. This is performed under anaesthesia and followed by intensive physical therapy.

Prevention

• Do regular strength training and range of motion exercises. This will help maintain a strong and flexible shoulder joint.
• Seek prompt treatment for a shoulder injury.
• Do activities that use your shoulder joint regularly.

Stages of frozen shoulder
Frozen shoulder develops slowly, and in three stages:

Stage 1
Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.

Stage 2
Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.

Stage 3
The condition begins to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months; surgery may be required to restore motion for some patients.

How can I prevent frozen shoulder?
To help prevent frozen shoulder:

• Do regular strength training and range of motion exercises. This will help maintain a strong and flexible shoulder joint.
• Seek prompt treatment for a shoulder injury.
• Do activities that use your shoulder joint regularly.

Your chances of a reoccurrence can be reduced if you return to practice and competition when all symptoms of the injury are gone and strength has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured area.

Improving sports performance
The key to improving sports performance after recovering from frozen shoulder is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone. Refer to the rehabilitation exercises regularly. Remember the following:

• Do regular strength training and range of motion exercises. This will help maintain a strong and flexible shoulder joint.
• Seek prompt treatment for a shoulder injury.
• Do activities that use your shoulder joint regularly.

Also, the single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• reduced stress
• enhanced enjoyment

Rehabilitation
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for frozen shoulder focuses on relieving pain and restoring function and range of motion to the shoulder.

Non-surgical rehabilitation includes:

• Pain relievers - ibuprofen and aspirin, to help reduce inflammation and relieve pain
• Muscle relaxants - to help relax arm and shoulder muscles
• Physical therapy - working with a physical therapist to stretch muscles and restore motion and function to the shoulder
• Heat and ice therapies - to help relieve pain and reduce swelling
• Corticosteroid injections - as prescribed and given by your doctor

The major objectives of rehabilitation from frozen shoulder are to increase flexibility, obtain pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms. In severe cases, you should avoid activity that causes shoulder pain altogether. In these cases, you can still maintain cardiovascular fitness by cycling, unless otherwise prescribed by your doctor.

Surgery may be needed if there is no improvement after several months. These procedures can successfully release and repair the shoulder, but it must be followed by an exercise program to maintain motion and restore function.
Surgeries include:

• Closed manipulation
  Forceful movement of the arm at the shoulder joint to loosen the stiffness
• Arthroscopic surgery
  Surgery to improve movement at the shoulder joint In these cases, your doctor may prescribe special physical therapy and recovery time will vary.
• Rehabilitation exercises
  If you have a stiff shoulder, see your physician to make sure you do not have any internal injury before starting any exercise program. It is important that you follow your physician's instructions carefully, especially regarding an exercise program. With your doctor's approval, you can do these simple exercises to help stretch and keep your shoulder mobile:
• Overhead stretch
  Lie on your back with your arms at your sides. Lift one arm straight up and over your head. Grab your elbow with your other arm and exert gentle pressure to stretch the arm as far as you can.
• Cross-body reach
  Stand and lift one arm straight out to the side. Keeping the arm at the same height, bring it to the front and across your body. As it passes the front of your body, grab the elbow with your other arm and exert gentle pressure to stretch the shoulder.
• Towel stretch
  Drape a towel over the opposite shoulder, and grab it with your hand behind your back. Gently pull the towel upward with your other hand. You should feel the stretch in your shoulder and upper arm.

Alternative exercises
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• water running
• stationary bicycle (add resistance gradually from one session to the next, as pain allows)

Rehabilitation after surgery
Surgery may be needed if there is no improvement after several months. These procedures can successfully release and repair the shoulder, but it must be followed by an exercise program to maintain motion and restore function. Surgeries include:

• Closed manipulation
  Forceful movement of the arm at the shoulder joint to loosen the stiffness
• Arthroscopic surgery
  Surgery to improve movement at the shoulder joint

When your doctor decides you are ready, you may start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises, and under no circumstance should you return to sports activity until your shoulder is fully healed.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

When can I return to my sport or activity?
Return to full participation should be avoided until your frozen shoulder has healed, full range of motion has returned, and you can perform all skills and other requirements of your sport without pain.

Remember:
the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your frozen shoulder recovers, not by how many days or weeks it has been since your injury occurred.