- Adam R Whatley Osteopath
Frozen Shoulder is a long very painful condition of the shoulder, whereby it is completely or partially unmovable. Frozen shoulder often starts randomly but may be triggered by a mild injury to the shoulder or it has a common relation to hormonal imbalances or diabetes. The condition usually goes through 3 phases, starting with 1) pain, then 2) stiffness and finally
3) thawing, whereby the shoulder goes through a stage of resolution as the pain eases and most of the movement returns slowly. This process may take a long time, sometimes as long as two or more years.
As mentioned above frozen shoulder is thought to be associated with diabetes as well as high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture.
The shoulder joint is surrounded by a joint capsule which is normally a very flexible elastic stucture to allow for high amounts of movement that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes initially inflamed and swollen. Then as this sets in the capsule loses normal elasticity and therefore its mobility.
Shoulder pain and tenderness intermittently
Pain with movement, Unable to raise arm above head.
Phases of frozen shoulder:
Freezing phase: Pain increases as inflammation builds. The pain incases with movement. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.
Frozen phase: Pain reduces however, mobility is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.
Thawing phase: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months
Most frozen shoulders improve over time, but it is a condition which is notorious difficult to treat. However, the pain and limitations of the stiff frozen shoulder generally require treatment. The treatment required depends on the severity of the pain and stiffness. These include:
Painkillers and anti-inflammatory medications only provide short term relief.
Osteopathic Treatment and physical rehabilitation aims to keep your shoulder mobile and strong, with further aims to reduce pain and weakness.
If conservative treatment fails then you may be offered a cortisone steroid injection into the area to help reduce inflammation and control the pain. However, it should be noted that these in most cases only offer short term relief and I’m not a solution long-term. Furthermore, It is advisable to avoid repeated steroid injections in the presence of infra-articular damage.
Platelet rich plasma (PRP) Treatment - a natural non-surgical treatment aiming to restore function and reduce pain. Also, a popular form of regenerative medicine which is used to preserve and store cartilage health
Surgery is required may be required in the form of a shoulder replacement if the shoulder arthritis is servre and has not responded to conservative management and rehabilitation. It is important to note that surgery requires a long period of rehabilitation following.
Osteopathy and physical rehabilitation - to prevent any further stiffness and regain range of motion
Painkillers and anti-inflammatories
Injections - reduce inflammation and
Surgery - If all else fails. This may involve an arthroscopic Capsular Release or Manipulation Under Anaesthetic. Intensive rehabilitation is essential after this procedure.
- REGENERATIVE MEDICINE. PLATELET RICH PLASMA (PRP) TREATMENT: Platelet-rich plasma (PRP) is a very popular ortho-biologic treatment use in regenerative medicine. Ortho-biologics are substances that occur naturally in the human body. When extracted, concentrated and injected back into the body, these substances activate the body’s own healing mechanisms. PRP treatment is performed by taking a small sample of the patient’s blood, extracting the platelets are then further contacting them before they are used to speed up healing and recovery. PRP injections are very commonly used to facilitate the body’s self-healing mechanisms, and the clinical outcomes are very good. Furthermore, it is completely natural and associated with minimal downtime. PRP has been shown in scientific research to be very effective for treating mild to moderate osteoarthritis, without the risks and expense of surgery. Most patients here at Dynamic Osteopaths & Regenerative Medicine report minimal discomfort associated with the injection. Also, go on to report significant improvement that occurs in the subsequent weeks. A recent study demonstrates that platelet-rich plasma treatment can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. The small study identified that following a single injection, a reported 60% improvement regarding diurnal shoulder pain, and reduced night pains. Also, two-fold improvement for mobility and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in further trials for success (link).
- HYALURONIC ACID (HA) INJECTION TREATMENT Two types of injections are normally used for treatment of pain from shoulder joint pain: steroid injections and hyaluronic acid (HA) injections. The goal of steroid injections is to reduce inflammation, however, these are only sort lived and can be damaging to the tissue. The goal of hyaluronic acid injections is to provide nourishment and lubrication for the shoulder joint and to protect the joint cartilage. As hyaluronic acid mimics our normal joint fluid that naturally lubricates joints. Hyaluronic acid injections are a type of treatment called viscosupplementation. As we age, we lose the fluid with inside our joints gradually, this then results in friction and slow degradation of the joint cartilage - causing inflammation and arthritis. Hyaluronic acid injections replace the normal fluid loss. Ideally, when injections are used they can be used in combination with a structured physical therapy program. The study here shown that the combination of intra-articular injection of hyaluronic acid with physical therapy program was more effective in comparison with the only physical therapy in reducing pain in patients affected by glenohumeral arthritis (link). PLEASE FOLLOW THIS LINK HERE FOR FURTHER SPECIFIC INFORMATION ON PRP & HA TREATMENT
Exercises for Frozen Shoulder It is important that the stabilising muscles are working to their best ability during the treatment of shoulder arthritis, and rehabilitation. The shoulder joint relies heavily on dynamic synergistic control while moving and if this is out, the shoulder biomechanics will be affected and the rotator cuff can also be susceptible to damage So, it is important to do some corrective stabilisation and strengthening exercises under the guidance of your osteopath, such as:
Rear scapular (shoulder blade) control
Rotator cuff strengthening
Shoulder mobility exercises
Stretching exercises are of the upmost importance of treating frozen shoulder. Always warm up your shoulder before performing your exercises. The best way to do that is to take a warm shower or bath for 10 to 15 minutes. You can also use a moist heating pad or damp towel heated in the microwave, but it may not be as effective.
In performing the following exercises, stretch to the point of tension but not pain.
1. Pendulum stretch
Do this exercise first. Relax your shoulders. Stand and lean over slightly, allowing the affected arm to hang down. Swing the arm in a small circle — about a foot in diameter. Perform 10 revolutions in each direction, once a day. As your symptoms improve, increase the diameter of your swing, but never force it. When you're ready for more, increase the stretch by holding a light weight (three to five pounds) in the swinging arm.
2. Towel Stretch
Hold one end of a three-foot-long towel behind your back and grab the opposite end with your other hand. Hold the towel in a horizontal position. Use your good arm to pull the affected arm upward to stretch it. You can also do an advanced version of this exercise with the towel draped over your good shoulder. Hold the bottom of the towel with the affected arm and pull it toward the lower back with the unaffected arm. Do this 10 to 20 times a day.
3. Finger Walk
Face a wall three-quarters of an arm's length away. Reach out and touch the wall at waist level with the fingertips of the affected arm. With your elbow slightly bent, slowly walk your fingers up the wall, spider-like, until you've raised your arm as far as you comfortably can. Your fingers should be doing the work, not your shoulder muscles. Slowly lower the arm (with the help of the good arm, if necessary) and repeat. Perform this exercise 10 to 20 times a day.
4. Cross body Stretches
Sit or stand. Use your good arm to lift your affected arm at the elbow, and bring it up and across your body, exerting gentle pressure to stretch the shoulder. Hold the stretch for 15 to 20 seconds. Do this 10 to 20 times per day.
5. Armpit Stretch
Using your good arm, lift the affected arm onto a shelf about breast-high. Gently bend your knees, opening up the armpit. Deepen your knee bend slightly, gently stretching the armpit, and then straighten. With each knee bend, stretch a little further, but don't force it. Do this 10 to 20 times each day.
Start to Strengthen
As your range of motion improves, add rotator cuff–strengthening exercises. Be sure to warm up your shoulder and do your stretching exercises before you perform strengthening exercises.
1. Outward rotation
Hold a rubber exercise band between your hands with your elbows at a 90-degree angle close to your sides. Rotate the lower part of the affected arm outward two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
2. Inward rotation
Stand next to a closed door, and hook one end of a rubber exercise band around the doorknob. Hold the other end with the hand of the affected arm, holding your elbow at a 90-degree angle. Pull the band toward your body two or three inches and hold for five seconds. Repeat 10 to 15 times, once a day.
Further specific exercises (below) can be adopted when tolerated
Therapy ball can be used to strengthen the core muscles
Rear shoulder strengthening (when tolerated)
PLEASE FOLLOW LINK HERE FOR SPECIFIC SHOULDER REHABILITATION FOLLOWING SHOULDER TENDONITIS