What is a frozen (contracted) shoulder?
The shoulder joint is a ball and socket joint. There is a loose layer of tissue, the capsule, which surrounds the joint keeping the lubricating fluid inside.
Contracted (frozen) shoulder involves this capsule which becomes irritated and inflamed. Scarring forms which contracts and causes the capsule to tighten this limits the movement of the shoulder joint. The shoulder does not feel cold, but it will feel very painful and stiff.
Why have I got a frozen (contracted) shoulder?
Very often it comes on gradually and for no apparent reason. It commonly occurs between the ages of 40 and 60 years old. It is 5 times more common in people with diabetes. 15% of people link the onset of contracted shoulder to a minor injury.
Will it get better?
Yes, it will get better eventually by itself but pain or restricted movement may last 3-4 years before subsiding. There are 2 main phases:
- Pain phase - pain is the predominant feature initially. Pain begins in the front of the shoulder but can radiate down the arm and sometimes you can get pins and needles in your hand. It is difficult to sleep and especially to lie on the affected side.
- Stiffness phase - the shoulder stiffens up and you will find difficulty with combing your hair, reaching overhead, reaching to your back pocket or bra strap. Over time the pain gradually begins to fade and it mainly occurs when you overstretch the arm. As the condition resolves your movements slowly improve and you can manage your day-to-day activities more easily.
What can I do to help myself?
In the early stages the priority is to get your pain under control. It is important not to try to force your movement through pain. This has been shown to make pain worse and the condition to last longer.
- Painkillers and anti-inflammatory medicines
These can be prescribed by your GP or pharmacist as a temporary measure to break the cycle of pain and aid sleep.
Applying moist heat to the shoulder can help particularly before exercises. You can apply a hot water bottle or wheat bag wrapped in a damp towel, or take a warm shower but take care not to burn yourself- comfortable warmth should be felt.
These can be used to reduce pain and inflammation when the pain is constant and severe. These work best in the early stages of the condition and can be administered by your GP or a Physiotherapist trained in Injection Therapy.
Although it is important not to over stretch or force movement in the early painful stage these can help in the later stages if done correctly. They will be described in more detail later.
If shoulder is too stiff it might not respond to these treatments. Your physiotherapist or GP will advise you on appropriate management. Other procedures include MUA (manipulation under anaesthetic), releasing the capsule with keyhole surgery or stretching it by putting fluid into the joint.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
Applications (Apps)
The ORCHA website will recommend useful and rated apps to support your wellbeing. https://www.orcha.co.uk/
Aims of Physiotherapy:
Physiotherapy may form one part of your management, helping you identify the main contributory factors whilst working together to plan your rehabilitation.
Your physiotherapist may spend time talking with you about your shoulder pain, providing advice, reassurance and helping discuss any concerns you may have.
A physiotherapist can provide and help oversee a personalised exercise programme focused on what you want and need your body to achieve.
If your symptoms fail to improve within 6 weeks with this regime you should contact your doctor for a physiotherapy referral.
