Frozen Shoulder - Staff Information Leaflet - Newcastle Hospitals

Frozen
  Shoulder

Staff Information Leaflet

This leaflet is designed to give you an understanding of Frozen Shoulders, the
treatment that may be beneficial and some advice on what you can do to help
 yourself. If your symptoms persist you should seek advice from your GP or
                          Occupational health service.
Introduction

The shoulder is a ball and socket joint (gleno humeral joint). It is designed to allow a
large amount of movement. Your arm (humerus) fits into the shallow socket (glenoid)
which is part of the shoulder blade (scapula). There is a loose bag or ‘capsule’ which
surrounds the joint.

What is a ‘frozen shoulder’?

A frozen shoulder (sometimes called an adhesive capsulitis) is a condition where the
shoulder becomes painful and stiff. It is thought that scar-like tissue forms in the
shoulder capsule and so the capsule loses its elasticity. Shoulder movements
become reduced, sometimes completely 'frozen'.

Who can get a frozen shoulder?

Frozen shoulder affects about 3% of adults at some stage in their life. It most
commonly occurs in people aged between 40 and 65 years of age and is more
common in women.

It is more common in people who have diabetes and some other conditions,
including overactive thyroid disease. It can also develop after an injury.

Either shoulder can be affected but most commonly it is the non-dominant shoulder
Note: frozen shoulder is not a form of arthritis and other joints are not
affected.

Why does it happen?

The exact cause of a frozen shoulder is not known. Sometimes a frozen shoulder
can develop without any identifiable reason. This can be referred to as a ‘Primary’
adhesive capsulitis.

In approximately 15% of cases, individuals have previously had a shoulder injury.
This is known as ‘Secondary’ adhesive capsulitis. This can also occur if the shoulder
area is kept still or not moved through its full range of movement for some time.

Symptoms

The typical symptoms are pain in the upper shoulder and mid upper arm and
stiffness or a lack of ability to move the arm well.

A frozen shoulder has three phases:

Phase 1

The ‘painful’ or ‘freezing’ phase:

There is usually a gradual onset of pain. The pain is described as a constant ache
with sharp pain if the shoulder is moved or knocked by something. The pain may be
worse at night.

It is advisable to take anti-inflammatory medication as advised by your GP or
pharmacist and use ice and heat during this stage. Local steroid injections from your
GP can also help at this time.

It is important to keep the shoulder moving during this phase. Remember if you don’t
move the arm the shoulder will stiffen more during phase two. Stage 1 typically lasts
2-9 months.

Phase 2

The ‘stiff’ or ‘frozen’ phase:

The pain begins to ease although the movement is still limited. It is important to
begin stretching exercises at this time to try to regain some elasticity back in the
capsule.

Your stretches should be uncomfortable when being performed, but the pain should
subside within 1-2 minutes after stretching. If you experience a dull ache pain that
lasts a long time after stretching, you may still be in stage 1 (refer to stage 1 section).
Stage 2 typically lasts 4-12 months.

Phase 3

The ‘resolving’ or ‘thawing’ stage:

The movement begins to return slowly. It is important to continue the exercises at
this stage to further increase the movement of the shoulder. During this stage, the
pain often only occurs when the shoulder is stretched and normal day to day
activities are pain free. This typically lasts between 1 and 3 years.

There is great variation in the severity and length of symptoms. Untreated, the
symptoms can last between 2 to 3 years.

What can I do to help myself?

Pain relief

Simple analgesia such as paracetamol and an anti-inflammatory such as Ibuprofen
can be very effective for the treatment of frozen shoulders. You can obtain advice
regarding medication from your local pharmacist or G.P, but remember to read the
packet and do not take over the recommended dosage.

Exercises

It is essential to exercise regularly to improve your movement. Do short, frequent
sessions (e.g. five to ten minutes, four times a day) rather than one long session.

Taking regular pain relief can help you perform the stretches and push yourself a
little further.

Do not continue the exercises if they significantly increase your pain. If this were to
occur, please see your GP / Physiotherapist for further advice.

Exercise 1 – Flexion

Stand with your legs apart and your hands on a table. Walk away from the table,
letting your upper trunk drop forwards until you can feel the stretch in your shoulders.

                                                (Hold for 10 seconds, repeat 5 times).

Exercise 2 – Abduction

In standing, grip one end of a stick with the involved arm. Push the arm out to the
side using the stick and the opposite arm.
                                                (Hold for 5 seconds, repeat 10 times).

Exercise 3 – External Rotation

Lie on your back with the affected arm resting on a pillow. Your elbows should be at
a 90 degree angle and be held close to the body. Push the involved arm out with
stick until you can feel a stretch in the arm / shoulder.
                                                   (Hold for 5 seconds, repeat 10 times).

Exercise 4 – Internal Rotation

In standing, grasp the wrist of your involved arm with the other hand and lift up
behind your back.
                                              (Hold for 10 seconds, repeat 5 times).

What about work?
Maintaining all normal activities including work improves your chance of recovery.
Working in discomfort will not lead to long term problems and has been shown to
reduce the risk of re-injury. It also helps to regain any strength that has been lost in
the early stages when the pain stopped you moving normally.

Stay active at work or return to work as soon as possible, with temporary lighter or
modified duties if necessary. This helps you keep your ‘work fitness’ and prevents
your body getting weak, which can prolong your pain.

Remember... You do not have to be pain free to return to or remain at work.

Some people have difficulty lifting the arm above their heads or behind their backs. If
you are having difficulties at work you should discuss these with your manager. It
may be possible to agree temporary restrictions to help you at work.

What should I do if I am still experiencing problems?
If you are unable to agree on restricted roles with you manager or you are still having
problems despite following this advice then your Occupational Health team can help.
The Occupational Health team can advise you on how to bridge the gap to help you
return to normal activities. You can also gain access to the Occupational Health
physiotherapist by:

Self referral

The Occupational Health service provides assessment and treatment of
musculoskeletal problems that affect your ability to work. Staff are able to self refer
to physiotherapy via the intranet Occupational Health web page

http://nuth-vintranet1/cms/SupportServices/OccupationalHealth.aspx

Management referral

If you feel your symptoms are having significant effect on your ability to carry out
your role, discuss this with your manager and request a referral to the Occupational
Health Physiotherapy team. The physiotherapist can assess your shoulder and
advise you on how to keep safe at work and avoid further problems. Any information
you share will be considered confidential and will only be passed on with your
permission.

For more information on frozen shoulder or how to stay active, why not try:

                        www.nhs.uk/Pages/HomePage.aspx

                              www.nhsinform.co.uk

                           www.activenewcastle.co.uk/

Physiotherapy Team
Ground Floor
Regent Centre
Regent farm road
Gosforth
NE3 3HD

Tel: (0191) 2821188

newcastle.ohs@nhs.net                                   Review date: October 2019