Is My Shoulder Frozen?

Shoulder pain can bother people of any age group or fitness level. A quick visit to Dr. Google may give you scary suggestions like cancer, but most of the time shoulder pain isn’t really that scary.

Without a traumatic injury, shoulder pain usually boils down to two common causes – frozen shoulder or rotator cuff injury. First and foremost, frozen shoulder most commonly affects people between the ages of 40 and 60, while rotator cuff issues can occur in any age group.

How do I know if I have frozen shoulder?

Symptom-wise, the two (frozen shoulder and rotator cuff injury) may be difficult to differentiate in the early stage, but as time goes by, the differences become more and more prominent. The key difference between the two conditions is the amount of passive shoulder movement available.

Passive shoulder movement refers to how much you can move your shoulder with the help of the other arm or other external force. You can test it by using the unaffected arm to elevate the affected arm or use the unaffected hand to push the affected hand up behind your back. It is important that the affected arm is relaxed as much as possible.

People with frozen shoulder are generally unable to elevate the arm or reach behind the back fully even with the help of the other hand. But people with rotator cuff problems commonly can still achieve normal range of movement, although it may be a little painful.

The diagnosis of frozen shoulder is made based on the symptoms. X-Ray and MRI are not necessary unless to rule out other potential pathology.

With frozen shoulder, many daily activities will be affected, like putting on clothes, showering, reaching up for objects, and carrying things. Unfortunately for ladies, putting on a bra becomes a daily challenge.

Why do I get frozen shoulder?

For some people, a frozen shoulder may be triggered by a minor injury, like a strain from playing sports, or carrying grocery, or doing housework. But for majority of the cases, frozen shoulder occurs without a reason. Its cause is still a mystery to date. But it is known to be more common in people with diabetes.

What to do if I have frozen shoulder?

If you are diagnosed with frozen shoulder, please be reminded that patience is gold. You will likely be living with it for one to two years. The recovery process of frozen shoulder is like a moving sloth. Be assured that it will recover, but it will stubbornly take a sloooooow pace. And sometimes, be prepared that it may have to get worse before it gets better.

A frozen shoulder will have to go through 3 stages – the freezing stage, the frozen stage, and the defrost stage.

The first stage is characterized by pain. Any movement involving the shoulder would be painful. In severe cases, some may experience resting pain and night pain that stops them from falling asleep. Initially, despite the pain, most patients are still able to move the shoulder through large range of movement, but it will become progressively restricted as time goes by.

Some months later, it will progress into the frozen stage, where the pain will gradually reduce but the stiffness will gradually increase. But hope will come around in the third stage, as the condition improves – the intensity of pain decreases, and range of movement improves. The whole process generally takes 1 to 2 years. Those with diabetes usually experience a slower progression due to their impaired healing capacity.

What types of exercises are good for frozen shoulder?

There are numerous exercises advocated for frozen shoulder. Before trying out the exercises, it is important to understand that not all stages of frozen shoulder will benefit from vigorous exercises.

When pain is debilitating in the first stage, the last thing you want to do is to vigorously move the shoulder and push through the pain. This will only aggravate the pain and make life more difficult for yourself. You need to learn to minimize any movement that gives you the pain.

Anti-inflammatory medication may help in some cases. Ask a pharmacist for recommendation for off-the-shelf anti-inflammatory medication. If that does not work, see an orthopaedic doctor. They may help by prescribing stronger anti-inflammatory medication or giving injection directly into the shoulder joint.

Exercises are more beneficial when the condition progresses into the second stage, where limited shoulder movement is the main presentation. The aim of the exercises is to maintain as much range of movement as possible. It is OK to experience some pain when doing the shoulder exercises in this stage, but the pain should be controlled within mild to moderate intensity.

With regular shoulder exercises, patients will be able to minimize the impact of frozen shoulder on daily activities and promote a smooth transition into the third stage.

At the third stage, it is time to use more vigorous exercises to help regain shoulder movement. It is important that patients need to tolerate some pain and push the shoulder into restricted range so that the movement can be improved every week.

How can physiotherapy help with frozen shoulder?

The role of physiotherapy treatment in this whole process is to guide patients through the different stages of frozen shoulder: knowing what not to do, what exercises to do, and when to progress with the exercises.

Physiotherapists also use manual therapy to help reduce pain and improve shoulder movement. In other words, physiotherapy for shoulder pain therapy allows for a smooth and hastened recovery process.

A side note for patients with diabetes – it is of great importance to keep your diabetes under control. This will promote a smooth recovery of frozen shoulder and reduce risk of recurrence in the long run.

Darek Lam

Senior Principal Physiotherapist

Shirley Le, writes in detail and this shows in her meticulous work with her patients. She constantly upgrades her clinical skills to be at the forefront of her physiotherapy practice.

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