Shoulder Stiffness/Frozen Shoulder/Adhesive Capsulitis

Shoulder Stiffness/Frozen Shoulder/Adhesive Capsulitis



Description


Loss of motion in the shoulder may occur for many reasons. In many situations, the stiffness is related to tightness of the soft tissues—the muscles, tendons, and the capsule around the joint. Normally, these tissues are flexible and allow the shoulder to maintain its usually large range of motion. When these tissues become thickened or scarred, they lose their resilience and suppleness. Sometimes the stiffness develops after an injury, after surgery, or for no apparent reason at all. Stiffness of the shoulder alters the normal shoulder mechanics. With supple soft tissues, the shoulder functions like a ball rotating within the center of a socket. When the soft tissues around the shoulder are stiff and less compliant, the soft tissues do not allow the ball to rotate. As a result, a compensatory gliding of the ball causes stretching of the capsule and pinching of other soft tissues, such as the rotator cuff; thus such stiffness is painful.



Common signs and symptoms



• Pain in the shoulder at rest or with motion

• Stiffness and loss of motion of the shoulder

• Loss of function and pain when moving the shoulder, such as reaching overhead or behind your back

• Uncommonly, numbness or paralysis in the upper arm from pinching, stretching, or pressure on the nerves

• Crepitation (crackling) or grinding with shoulder motion


Causes



• Shoulder stiffness is idiopathic, meaning the cause is often unknown.

• Stiffness may occur after major or minor injury, and pain may limit any desire to move the shoulder.

• Surgery of the shoulder may result in stiffness.


Factors that increase risk



• Diabetes

• Trauma

• Surgery of the shoulder

• Previous shoulder dislocation, sprain, or fracture

• Repeated shoulder injury of any kind


Preventive measures



• Attempt to move your shoulder after an injury, if allowed by your physician, to limit the stiffness in the joint.

• Warm up and stretch before practice and competition.

• Strengthen your shoulder muscles.

• For contact sports, wear protective shoulder pads.


Expected outcome


Shoulder stiffness that occurs without injury or surgery typically progresses through three phases: a freezing phase, with painful loss of motion; a frozen phase, with stiffness and pain at the end ranges of motion; and a thawing phase, in which motion is slowly regained. These phases may occur over time, ranging anywhere from 3 to 36 months. Recovery may be hastened with appropriate treatment, but it is very likely you will not regain 100% of your previous range of motion.



Possible complications



• Permanent stiffness and loss of motion

• Prolonged healing or recurrent stiffness

• Rotator cuff injury, including tears

• Risks of surgery, including infection, bleeding, injury to nerves, inability to regain all your motion, further loss of motion, and fracture of the shoulder


General treatment considerations


Most stiff shoulders are treated effectively with a simple rehabilitation program to slowly regain range of motion. These exercises may be done at home or with a physical therapist, and they are usually very effective at safely regaining motion. Although months of these specific exercises may be required, persistence almost always pays off, such that surgery may be avoided. Medications and ice are recommended to reduce discomfort and allow you to do the exercises. Use of a sling is discouraged, as this may result in even more stiffness, but your physician may recommend an injection of cortisone in your shoulder to help relieve pain. If the exercises do not restore motion, your physician may recommend an injection of fluid into your joint to stretch it. Another option commonly offered is manipulation under anesthesia (MUA). With this procedure, you are put to sleep in an operating room with anesthesia, and a doctor moves your shoulder to break up the scar tissue and other tissues that may be limiting your motion. Your surgeon may also recommend arthroscopic surgery to cut the tissues that are limiting your motion. After MUA or arthroscopy, you will need to undergo physical therapy to maintain the motion gained from the surgery.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take if surgery is planned within 7 days), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed, and call your doctor if any bleeding, stomach upset, or allergic reaction occurs.

• Stronger pain relievers may be prescribed. Use these only as directed, and take only as much as you need.

• Cortisone may be injected into your shoulder joint or near the rotator cuff to reduce the inflammation and pain to allow you do to the exercises; however, the number of cortisone injections you can have is limited, as they may weaken or damage muscles and tendons.

• General anesthesia and muscle relaxers may be used for MUA or surgery.


Cold therapy


Apply cold for 20 minutes every 2 to 3 hours to reduce pain and inflammation after injury or after activity that aggravates your symptoms. Use ice packs or an ice massage.



When to call your doctor



• Pain, tenderness, or swelling worsens despite treatment.

• You experience pain, numbness, or coldness in your arm.

• A blue, gray, or dusky color appears in your fingernails.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.


Range of Motion and Stretching Exercises


Shoulder Stiffness/Frozen Shoulder/Adhesive Capsulitis


Shoulder stiffness can be broken down into three phases: 1) freezing, 2) frozen, and 3) thawing. Stiffness and motion vary according to the diagram. As stiffness increases, range of motion decreases, and vice versa.



Phase I: Freezing


These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. During the freezing phase, no matter what you do, you will tend to lose motion, and your shoulder will become more painful. Therefore the goal for the exercises prescribed for you in phase I is to minimize your loss of range of motion and strength and minimize any associated pain and inflammation. Please remember:


• Flexible tissue is more tolerant of the stresses placed on it.

• A gentle stretching sensation should be felt, and it should not provoke or increase your pain.
image

image


Range of motion image shoulder pendulum



1. Lean forward at the waist, letting your weak arm hang freely. Support yourself by placing your opposite hand on a chair, table, or counter as shown.

2. Sway your whole body slowly, forward and back. This will cause your arm to move. Let your arm hang freely, and do not tense it up.

3. Repeat the above, swaying side to side and moving in circular patterns, clockwise and counterclockwise.

4. Do ____ repetitions in each direction.

5. Repeat this exercise ____ times, ____ times per day.
image


Range of motion image shoulder flexion, single arm



1. Lie on your back and grasp the bottom of a stick, handle of an umbrella, or blade of a golf club in the hand of your weak arm as shown.

2. Using the stick, raise your arm overhead as shown, until you feel a gentle stretch. Lead with your thumb in a “thumbs up” position.

3. Hold each repetition for ____ seconds, and slowly return to the starting position.

4. Repeat this exercise ____ times, ____ times per day.
image


Range of motion image shoulder flexion



1. Sit in a chair with your weak arm on a table as shown.

2. Lean forward slowly, sliding your arm forward on the table, until you feel a gentle stretch.

3. Hold this stretch for ____ seconds, and return to the starting position.

4. Repeat this exercise ____ times, ____ times per day.
image


Range of motion image shoulder flexion



1. Stand near a wall as shown, and slowly “walk” your fingers up the wall, until you feel a gentle stretch.

2. Hold each repetition for ____ seconds, and slowly return to the starting position.

3. Repeat this exercise ____ times, ____ times per day.

image


Range of motion image shoulder external rotation



1. Lie on your back or stand with your weak arm at your side and your elbow bent to 90 degrees. Hold a stick, umbrella handle, or golf club in your hand as shown.

2. Using the stick, rotate your hand and forearm away from your body as shown. Make sure you keep your upper arm and elbow close to your side.

3. Hold each repetition for ____ seconds, and slowly return to the starting position.

4. Repeat this exercise ____ times, ____ times per day.


Strengthening Exercises


Shoulder Stiffness/Frozen Shoulder/Adhesive Capsulitis



Phase I: Freezing


These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. The goal for these exercises is to allow you to maintain as much strength as possible without increasing your pain. Do not stop using your arm, rather use it to the greatest extent possible while not increasing your pain. Please remember:


• Strong muscles with good endurance tolerate stress better.

• Do the exercises as initially prescribed by your physician, physical therapist, or athletic trainer. Progress slowly with each exercise under their guidance, gradually increasing the number of repetitions and weight used.

image


Strength image shoulder flexion, isometric



1. Stand and raise your weak arm straight out in front of you as shown.

2. Place your other hand on top of your arm, and push down as hard as you can without having any pain and without moving your arm.

3. Hold this position for ____ seconds. Relax.

4. Repeat this exercise ____ times, ____ times per day.
image


Strength image shoulder abduction, isometric



1. Stand and raise your weak arm slightly away from your body as shown.

2. Place your other hand on top of your arm, and push down as hard as you can without having any pain and without moving your arm.

3. Hold this position for ____ seconds. Relax.

4. Repeat this exercise ____ times, ____ times per day.

image


Strength image shoulder external rotation, isometric



1. Bend the elbow of your weak arm to 90 degrees, holding your arm slightly in front of you as shown.

2. Place your opposite hand over your wrist as shown.

3. Try to rotate your arm outward, away from your body, as if it were a gate swinging open. Resist this motion with the hand over your wrist. Do not let any motion occur.

4. Hold this position for ____ seconds. Relax.

5. Repeat this exercise ____ times, ____ times per day.
image


Strength image shoulder internal rotation, isometric



1. Bend the elbow of your weak arm to 90 degrees, holding your arm slightly in front of you as shown.
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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Shoulder Stiffness/Frozen Shoulder/Adhesive Capsulitis

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