Have you been having trouble reaching for the coffee mugs and dishes on the top shelves of your cabinets? Do you find it difficult to put your arm through the sleeve of a button-down shirt? How about reaching for your seat belt? If moving your arm is painful and your motion is limited, you might have a case of frozen shoulder (FS).
Although there are numerous sources that can be responsible for pain and restriction in the shoulder region, here is a test to help you identify if your shoulder is impaired. Stand in front of a mirror and raise your "good" arm up as high as it will go, then bring it back down to your waist. Remember that position. Now, raise your "bad" arm to the same level. If it hurts or stops short, you might be dealing with FS.
One of the most common causes of shoulder pain, frozen shoulder affects millions of Americans each year. Mechanical frozen shoulder is the most common type and it has three distinct stages: freezing, frozen and thawing.
The history of frozen shoulder is typically not clear. As FS occurs without warning in an overwhelming percentage of its cases, people will frequently have difficulty recalling an incident of trauma or pain that may have led to their current situation. This often frustrates patients and makes it difficult for a therapist to establish a recovery timeline.
Frozen shoulder does have a natural life span. While each stage is remarkably different, they all last for about six to nine months without treatment. It is not unusual for patients to have persistent stiffness for over two years if the problem is not addressed.
The first phase of frozen shoulder, the freezing stage, is the most painful. There is a group of tissues that surround the ball and socket and keep it in place. When FS begins, these tissues contract, tighten and scar down - a mechanism that is not yet fully understood in medicine. Function is heavily impacted in this stage and most people will consume high amounts of pain medication to help them get through the day.
The next stage, frozen, is the most limiting. Strangely, most people will experience little to no pain in this stage. Movement deficits are at their peak and even simple things such as getting milk from the refrigerator and combing your hair are now impossible. Most patients retain the ability to lift their arm to 90 degrees, but it is not uncommon for the shoulder to freeze completely, rendering motion above the waist nearly impossible.
Small amounts of pain will return during the thawing stage. This pain is indicative of scar tissue breakdown and restoration of normal motion. Many patients will have to wait well over a year before this phase begins in the absence of therapy.
The relationship between treatment and recovery is strong. With swift intervention, a case of FS may resolve in as little as four to six weeks, but normally will last upwards of two months.
A course of rehabilitation involves aggressive manual mobilizations and stretches coupled with frequent home exercises. Frozen shoulder responds best to intensity. It needs to be firmly manipulated to re-model the scar tissue that has built up over the past several weeks. Small, light movements will not yield a successful outcome, so patients must expect a moderate amount of pain from the outset.
I have found that most patients have an excellent capacity to make a full return to
pre-injury levels with strong commitment to physical therapy. Frozen shoulder is difficult to chase away with minimal rehabilitation. Marginal effort yields marginal return, so I strongly encourage patients to endure the discomfort of a therapeutic program.
The plateau for progress varies with motivation — so work hard. With the right focus and a bit of perseverance, you'll pass that mirror test soon.
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Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly.¬ Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail features@eagletribune.com.
