EXERCISE AND TREATMENT FOR FROZEN SHOULDER PAIN......

                      WHAT IS A FROZEN SHOULDER

Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin slowly, then get worse. Over time, symptoms get better, usually within 1 to 3 years.

Symptoms

Frozen shoulder typically develops slowly in three stages.

• Freezing stage. Any movement of the shoulder causes pain, and the shoulder's ability to move becomes limited. This stage lasts from 2 to 9 months.
• Frozen stage. Pain might lessen during this stage. However, the shoulder becomes stiffer. Using it becomes more difficult. This stage lasts from 4 to 12 months.
• Thawing stage. The shoulder's ability to move begins to improve. This stage lasts from 5 to 24 months.

For some people, the pain worsens at night, sometimes disrupting sleep.

Causes

The shoulder joint is enclosed in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

It's unclear why this happens to some people. But it's more likely to happen after keeping a shoulder still for a long period, such as after surgery or an arm fracture.

Risk factors

Certain factors may increase the risk of developing frozen shoulder.

Age and sex

People 40 and older, particularly women, are more likely to have frozen shoulder.

Immobility or reduced mobility

People who've had to keep a shoulder somewhat still are at higher risk of developing frozen shoulder. Restricted movement can be the result of many factors, including:

• Rotator cuff injury
• Broken arm
• Stroke
• Recovery from surgery

Systemic diseases

People who have certain diseases appear more likely to develop frozen shoulder. Diseases that might increase risk include:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Parkinson's disease

Prevention

One of the most common causes of frozen shoulder is not moving a shoulder while recovering from a shoulder injury, broken arm or stroke. If you've had an injury that makes it difficult to move your shoulder, talk to your health care provider about exercises that can help you maintain your ability to move your shoulder joint.

Diagnosis

To diagnose frozen shoulder, your doctor will give you a physical exam. They'll check it to see how badly it hurts and how far it moves. During the “active” part of the exam, they’ll let you move your shoulder on your own. During the “passive” portion, they’ll move it for you, and note the differences.

Your doctor may decide you need an injection of anesthetic in your shoulder. This is a medication that will numb the pain so that they can better judge your active and passive ranges of motion.

A physical exam is usually enough to diagnose frozen shoulder, but your doctor may also order imaging tests such as X-rays, ultrasound, or MRI to rule out other problems like arthritis or a torn rotator cuff that can also cause pain and limit how far it moves.

Treatment

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can help relieve the pain and inflammation in your shoulder. If they don’t help, your doctor might prescribe a stronger medication.

Your treatment might also include going to a physical therapist for strengthening and stretching exercises to improve your range of motion.

If your symptoms are intense or don’t improve over time, your doctor might recommend other kinds of treatments, including:

• A corticosteroid injection in your shoulder joint to reduce your pain and improve your range of motion.
•  Joint distension. This means your doctor will inject sterile water into your shoulder capsule to stretch it. This can help you move your shoulder more easily.
• Physical therapy. Results with this are mixed, and it may be more useful during certain phases of frozen shoulder than others.
• Surgery. This is very rarely necessary to treat frozen shoulder. But if other treatments haven’t helped, your doctor may suggest surgery. It likely would be an arthroscopic procedure. That means it’s done with lighted, pencil-sized tools that are inserted through tiny cuts in your shoulder.
• Shoulder manipulation can help loosen up your shoulder tissue but is very rarely done anymore because arthroscopic surgery has replaced it. Surgeons would forcefully move the shoulder under general anesthesia. With this method, there was an increased risk of complications including fractures.

EXERCISE FOR FROZEN SHOULDER

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