By Sarah Jayas | Summer 2017

What is a frozen shoulder?

When someone has a frozen shoulder, the tissue around the shoulder joint gets thick and tight, causing stiffness and pain, and making the shoulder hard to move. The effects of a frozen shoulder can be long-lasting and can get worse without treatment.

What is the cause?

Frozen shoulder usually starts after an injury or surgery that keeps you from being able to move your shoulder for several weeks. Limited movement can cause scar tissue or adhesions to form in your shoulder joint. Sometimes, however, a frozen shoulder may occur for no known reason.

You may be at higher risk for a frozen shoulder after an injury or surgery if you have a medical condition such as diabetes, thyroid disease, heart disease, and/or arthritis.

What are the symptoms?

Symptoms may include:

• Pain in your shoulder that comes on slowly over several weeks to months
• Increased pain caused by movement of the shoulder
• Pain for several weeks, followed by stiffness or trouble moving your shoulder, such as not being able to lift your arm above your head, scratch your back, reach your back pocket, or put on a bra.
• A grinding sound or feeling when moving your shoulder.

How is it diagnosed?

Your health-care provider will ask about your symptoms and medical history and will examine you. Tests may include:

• X-rays
• Arthrogram (an X-ray of your shoulder after dye is injected into your shoulder joint)
• Ultrasound
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the shoulder

At first, the most important thing to do is rest your shoulder and avoid reaching, lifting, and raising your arms overhead as much as possible.

How is it treated?

Even without treatment, the pain and stiffness of a frozen shoulder usually get better on their own, but it can take months to heal completely. Treatment can help the symptoms. The usual course of treatment for a frozen shoulder includes the following:

• At first, the most important thing to do is rest your shoulder and avoid reaching, lifting, and raising your arms overhead as much as possible.
• See your health-care provider and/or physiotherapist about exercises to prevent further symptoms and to make the shoulder muscles stronger. He or she can show you how to do these exercises and tell you when to start them and how often to do them. Do the exercises as recommended but make sure to start slowly. Also, know that some pain is normal, but it's important not to push it. If you have sharp or tearing pain, stop what you're doing and let your health-care provider and/or physiotherapist know.
• Ask your health-care provider and/or pharmacist about taking an over-the-counter medicine for pain, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read the label and take as directed.

• Note that nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Unless recommended by your health-care provider, you should not take these medicines for more than 10 days.
• Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3,000 milligrams (mg) of acetaminophen in 24 hours. To make sure that you don't take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

• Make sure you know when you should come back for a follow-up. Keep all appointments for health- care provider visits and/or tests.
• And ask your health-care provider and/or physiotherapist:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

What if my shoulder doesn't get better?

If your symptoms don't get better, talk with your health-care provider about other possible treatments, such as:

• Getting a shot of a steroid medicine into your shoulder joint to help with pain and swelling.
• If your shoulder doesn't get better with exercises and medicine, you may need a procedure to break up the scar tissue in your shoulder. You will be given a general anesthetic to relax your muscles and keep you from feeling pain. You will be asleep during the procedure. The health-care provider will move your shoulder in various directions to break up the bands of scar tissue.
• You may need arthroscopic surgery to remove scar tissue. Arthroscopy uses a lighted tube with a camera to see inside your shoulder. Your provider can put the scope and tools through small cuts to repair your joint.

How long will the effects of frozen shoulder last?

The length of recovery depends on many factors such as your age, health, and if you have had a previous shoulder injury. The effects of a frozen shoulder can be long-lasting and can gradually worsen if the appropriate treatment is not received. Since a frozen shoulder can be caused by several factors, it is important that these be corrected.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. The return to your activities will be determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon, you may worsen your injury. You may safely return to your normal activities when:

• Your injured shoulder has full range of motion without pain.
• Your injured shoulder has regained normal strength compared to the uninjured

How can I help prevent frozen shoulder?

After you have had an injury to your shoulder, it is important that you do not limit your shoulder motion for any longer than you have to. This is even more important if you have diabetes, arthritis, and/or heart disease.

Do shoulder rehabilitation exercises as they have been prescribed. If you feel that you are losing range of motion in your shoulder, see your health-care provider promptly.

Sarah Jayas is a registered nurse and team leader with Health Links - Info Santé, a telephone health information service with the Provincial Health Contact Centre at Misericordia Health Centre.

The information for this column is provided by Health Links - Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé.

Call: 204-788-8200
Toll-free: 1-888-315-9257