In this post we are going to talk you through Frozen Shoulder and Physiotherapy. This condition can be a very painful and debilitating and may be one of many reasons people seek help from a physiotherapist. This article will take you through some features of the condition, how it can present to physiotherapy, and some of the ways we might be able to help you at Roundwood Health Clinic in Barnsley if you are diagnosed with a frozen shoulder.
Frozen Shoulder and Physiotherapy
Background and diagnosis
There are 2 main types or classifications of frozen shoulder – the medical term for is adhesive capsulitis but more on this later!! The first classification is a primary frozen shoulder and essentially this means that it has come on for no apparent reason. What we find in the physio clinic is that patients will very often tell us it starts as a pulled muscle type feeling in the bicep but that initially there is no restricted movement in the shoulder. Eventually over time these symptoms get worse and patients start to notice pain and problems with everyday functions like reaching with the arm and putting the hand behind the back.
With a more severe frozen shoulder patients can often also get pain at night and even pain when they are just resting their arm down by their side. Physiotherapists previously believed that frozen shoulder affected women more than men and was usually on their non-dominant arm but some recent research has suggested that it affects men and women more equally than previously thought.
Frozen shoulder tends to affect patients over 40 and we definitely see this in physiotherapy practice here at Roundwood. The cause of a frozen shoulder is very poorly understood but what happens is that the capsule of the shoulder becomes inflamed for some reason and the fibres within it then constrict and tighten thus greatly restricting the movement in the shoulder and making it very painful. There are some conditions that make it more likely that you will develop a frozen shoulder and these include diabetes, heart disease, high cholesterol and possibly thyroid problems. Thankfully frozen shoulder tends to only occur on one side of the body and if you have had it previously it does not mean that you are likely to experience it again.
Secondary Frozen Shoulder
With secondary frozen shoulder this starts for a known reason. For example, the patient might have fractured their wrist and this has stopped them moving their shoulder normally, or the patient could have had surgery in or around their shoulder, trunk or limb and again the frozen shoulder may have started as a consequence of this. How we treat both types of frozen shoulder with physiotherapy is similar and usually the best thing to do would be to book in for an initial assessment and the physiotherapist can discuss your shoulder and treatment options. It is also worth bearing in mind that lots of people are mis-diagnosed as having a frozen shoulder so if your colleague or family member tells you they had a frozen shoulder that got better in a week it probably wasn’t a frozen shoulder but was one of the many other problems that can affect the shoulder!
Frozen Shoulder Phases
A frozen shoulder usually has 3 phases – the freezing stage, the frozen stage and the thawing stage. It’s probably wrong to say that these phases are distinct from one another as in reality they are more likely to blend together as you slowly move from one phase to the other. What stage you are at in the frozen shoulder, how severely the movement is restricted and how much it is affecting your life will help your physiotherapist to decide on the best treatment plan for you.
See your GP
As with most things if you are concerned about your symptoms, they are new or unusual to you then you should always consult your GP. In addition if you have a history of cancer or any other serious illnesses again you should chat to your GP about the symptoms you are experiencing with your shoulder. Other areas of the body can also refer (or send pain) to the shoulder – for example your gallbladder, heart, lungs and neck – so if you know you have any problems with these or are worried in any way about these then please let your GP know.
Physiotherapy aims to help you regain the movement in your shoulder/ arm as well as reducing your pain and helping you to use your arm better. It may involve things like hands on therapy, stretches, acupuncture, exercises and many more things we have in or “toolbox” to help you. The general advice is usually to keep your shoulder gently mobile without causing yourself agonising pain and you may also find that some heat applied to the area might help you to move your shoulder a bit more (always take care of your skin and don’t overheat the area). Frozen shoulder can take quite some time to improve and you will not need to have physiotherapy for the whole time but it is thought that physiotherapy can help you to move through the phases more quickly and get you back doing the things you enjoy. What we find clinically is getting your arm up behind your back is usually the last movement to return so try not to worry too much about that movement!
Unfortunately for some people the frozen shoulder is either just too severe, the physiotherapy doesn’t improve the shoulder or they are just in so much pain that they need something else to help them. In this case the next step may be to have a steroid injection placed into the shoulder under ultrasound guidance and this can often help to improve the pain for the patient. These are available at Roundwood Health Clinic through one of our specialist physiotherapists – you can either ring to book or book online, or you can arrange via your GP. Further information on injections can also be found on our website at: www.roundwoodclinic.co.uk
Unfortunately for a very small number of patients whose frozen shoulder is very stubborn and continues to cause them a lot of problems, they may need to be referred to see a Consultant Orthopaedic Surgeon for an operation. Again, your physiotherapist can advise you and liaise with your GP if you fall in to that category and again, you will be sent back to us after your operation to help you get your arm moving again.
I hope this blog has given you some background information on physiotherapy and frozen shoulder and hasn’t made you fall asleep!). It’s not meant to replace the expertise of your physiotherapist or GP so always seek further advice if you need to. As I’ve mentioned there are many other shoulder conditions that are sometimes diagnosed as frozen shoulder – like labral tears, rotator cuff tears, impingement syndrome – so watch this space in the next few months for further shoulder related blogs!
For further advice or to book an appointment to see one of our experienced physiotherapists press the “book now” button for online bookings or call us on (01226) 282560.