INTRODUCTION
Frozen shoulder is a disorder characterized by pain with significant loss of its range of motion in all directions. This often causes considerable pain during sleep with difficulty in finding a comfortable position in bed. Pain usually progresses with time and leads to loss of motion in the shoulder as one attempts to limit the pain by voluntarily decreasing the amount of motion in the shoulder.

It affects 2-5% of the population

It seems to affect mainly the over-40s

It is five times more common in diabetics

It is more common in women (60%)

It may have a genetic component i.e. it can run in the family

About 15% of people get it on both sides

CAUSES
Your shoulder is a ball-and-socket joint. The round end of your upper arm bone fits into a shallow cavity on your shoulder blade. The joint is surrounded by tough connective tissue known as the shoulder capsule. Inflammation and tightness of this shoulder capsule leads to a frozen shoulder. Adhesions may develop between your joint's surfaces as a result of inflammation. Synovial fluid, present in the joint space which helps to keep your joint lubricated and moving smoothly, may decrease.
Although the exact cause is unknown, certain factors may increase your risk of getting frozen shoulder. These factors include:

Minor injury, overuse or prolonged immobilization of your shoulder, such as after surgery or an arm fracture.

Systemic diseases: People with overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), cardiovascular disease or Parkinson's disease.

Some form of stress or bed rest following illness.

Symptoms

Shoulder pain; usually a dull, aching pain located over the outer shoulder area and sometimes the upper arm. For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

Limited movement of the shoulder

Difficulty with activities such as combing hair, putting on shirts/bras , reaching for your wallet in your back pocket

Pain when trying to sleep on the affected shoulder

Diagnosis

During examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement.

Underlying diseases involving the shoulder can be diagnosed with the history, examination, blood testing, and x-ray examination /MRI of the shoulder.

Stages of a frozen shoulder
Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months:

Painful stage:During this stage, pain occurs with any movement of your shoulder and your shoulder's range of motion starts to become limited. This painful stage typically lasts 6-12 weeks

Frozen stage: Pain may begin to reduce during this stage. However, your shoulder becomes stiffer and your range of motion decreases notably. The frozen stage can last 4-6 months

Thawing stage: The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.

TREATMENT
Pain control-- This can be achieved with anti-inflammatory medications and physiotherapy which may include ultrasound, electric stimulation or heat therapy.
Restore movement:
Exercises and Stretching-The physiotherapist moves the patient's arm passively to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley. The therapist will instruct you on a stretching and strengthening routine that you should do at least once or twice a day. These exercises include the use of a stick, an over door pulley system to increase motion of the shoulder. Along with this you’ll also be given an exercise band or cord to minimise the loss of muscle on the affected shoulder.
It is very important for those with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. Particular care should be taken to avoid sudden, jerking motions of or heavy lifting with the affected shoulder
With physiotherapy, medication and self-care efforts, most people with frozen shoulder eventually regain nearly full shoulder movement and strength as signs and symptoms improve.

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If you are suffering from pain in your back, you can book an appointment to see our Senior Physiotherapist. We are located right in the heart of Singapore, at Orchard, and are available Mondays through Saturday.