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Cold Shoulder

The cause of frozen shoulder is a mystery. For millions of Americans, its symptoms are debilitating. Fortunately, the condition can be cured and, in many cases, prevented altogether.

Timeline of a Meltdown
Aggravating Enigma
Unlocking the Joint
Beat the Freeze
Frozen Shoulder Workout
Resources

The shoulder is the most mobile joint in your body, integral to many everyday movements. So when something goes wrong in this critical connector, it can be a real pain in the – well, shoulder.

"Frozen shoulder" affects an estimated 6 million Americans, causing severe pain and loss of range of motion. It makes the most basic motions of everyday life, such as reaching into your back pocket, brushing your hair or fastening a seat belt, nearly impossible to perform.

The condition is frustrating and painful, but experts say that with time and some simple exercises, frozen shoulders will eventually thaw. "The prognosis is very positive," says Rick Sandor, MD, a physician at Camino Medical Group in Sunnyvale, Calif., who specializes in sports medicine and has contributed to medical literature on frozen shoulder. "You just need to be patient and persistent."

Timeline of a Meltdown
In medical terminology, frozen shoulder is known as adhesive capsulitis. The disorder occurs when the joint capsule shrinks and scars, restricting range of motion and causing pain. It resembles rotator cuff tendinitis, with one key difference: A frozen shoulder is not only too painful to move, it literally won't move through its normal range of motion. The progression of frozen shoulder typically follows three stages:

FREEZING: Ten to 36 weeks of severe pain, often at night, and progressive loss of motion.

FROZEN: The joint locks up. Pain may decrease without improved motion. This phase can persist for four to 12 months.

THAWING: The joint gradually regains range of motion on its own or with therapy. This phase may take years.

Aggravating Enigma
Frozen shoulder usually strikes people after age 40, and it affects women more often than men. The cause remains a mystery. In some cases, it occurs following shoulder trauma or surgery, or it comes about when people begin to suffer from diseases, such as hyperthyroidism or diabetes. (In fact, 10 to 20 percent of diabetics are affected by frozen shoulder at some point.) Other times, there is no apparent cause.

Some doctors suspect that a limited range of motion in the shoulder – whether because of lifestyle or injury – contributes to development of the condition. Stephen G. Rice, MD, director of sports medicine at the Jersey Shore University Medical Center in Neptune, N.J., has seen a pattern of frozen shoulder in patients who are forced to immobilize their arms for other injuries. Sometimes a shoulder locks up with astonishing speed – just days after broken or strained arms are put into slings. "Basically, it's the classic 'use it or lose it' situation," says Rice, a spokesperson and fellow of the American College of Sports Medicine.

Unlocking the Joint
Fortunately, frozen shoulder can often be healed with simple at-home exercises or the help of a physical therapist. But it takes time.

"People hit a point they think they can't get past, and then all of a sudden the shoulder just releases," says Scott Brone, CSCS, a physical therapist in Charlotte, N.C. Patients nearly always recover, although it may take months or even years. Here's how to facilitate healing:

1. Control the pain. Left unchecked, frozen shoulder can become one of those nasty self-perpetuating cycles in which pain discourages movement, and this lack of activity makes the situation worse. That's why bringing pain under control is an essential first step. Icing the shoulder for 20 to 30 minutes several times a day reduces discomfort. More intense pain may require over-the-counter anti-inflammatory drugs. Avoid motions that cause pain. If an activity hurts, such as opening a door, use your other arm, or ask for help.

2. Start to move. Movement is essential to thawing a frozen shoulder. Sandor advises patients to perform exercises that take them to the edge of their comfort zone. "Be gentle but persistent," he says. "Once the pain is under control, you can be as active as your range of motion allows you to be."

For a small percentage of cases, surgery may be required. Oftentimes, these procedures do not actually require cutting. Instead, doctors anesthetize the patient and then manipulate the shoulder through its range of motion to break up the scar tissue. In other cases, surgeons need to cut into the joint to release the capsule.

Beat the Freeze
So how do you avoid freezing up in the first place? Stay limber, and maintain strong, well-balanced muscles.

Move your shoulders safely through their full range of motion every day by stretching and swinging your arms. "In 30 seconds to a minute, you can do all the exercises you need to reduce your risk of frozen shoulder," Rice explains. For basic shoulder exercises, go to www.mayoclinic.com and search "How to Stretch."

Muscle imbalances and inflexibility may also contribute to shoulder problems, says Tim Hawkins, massage therapist and cofounder of the Windhawk Clinic in Mesa, Ariz. He notes that shoulders often roll forward because people spend so much time sitting at the computer and driving – activities that cause the pectoral muscles in the chest to become tighter and the rhomboid muscles between the shoulder blades to weaken. "Over time," he says, "that imbalance can cause the shoulder to tighten up."

The body, Hawkins explains, is a master of conservation that shuts down parts that aren't used regularly. Hawkins helps patients restore their range of motion with active isolated stretching and a massage technique called myofascial release, a blend of stretching and massage.

Integrative techniques that take the structure of the whole body into consideration can also help correct frozen shoulder. William James Brooks, DO, of Comprehensive Osteopathic Manipulative Medicine in Kansas City, Mo., says joint problems like frozen shoulder may occur as a secondary effect of a more severe mechanical malfunction elsewhere in the body. He recalls one frozen-shoulder patient who came to him because she continued to have pain after traditional orthopedic treatment and manipulation under anesthesia. When Brooks examined the patient, he found mechanical dysfunction throughout her upper body. After osteopathic manipulation, she reported complete relief.

But, alas, Brooks says there are no universal cures for ending joint dysfunction. "Each person tends to malfunction in his or her own unique way," he says. Your best strategies for avoiding and resolving problems like frozen shoulder? 1) Maintain a balanced fitness program; 2) Work with a skilled integrative practitioner who can put "isolated problems" in a whole-person context that considers the entire musculoskeletal system.

Whichever route you may consider taking to cure a frozen shoulder, the take-home message boils down to prevention as the best medicine: Exercising the shoulders and keeping your body in balance gives you the best odds of avoiding the deep freeze of adhesive capsulitis.

Kermit Pattison has written for The New York Times and GQ.


Frozen Shoulder Workout
If your shoulder is "frozen," these beginning exercises from The Physician and Sportsmedicine – available in the "Personal Health" section at www.physsportsmed.com – may help:

The Pendulum: Bend forward at the waist, letting your injured arm hang toward the floor. Place your other arm on a table to support your weight. Begin to sway back and forth, gradually making small circles with your dangling arm. When this can be done easily, add small weights. Begin with two sets of 10, both clockwise and counterclockwise. Work up to three sets of 20.

Table Crawls:

Sitting beside a table, place the forearm of your injured arm on the table with a towel under your palm. Using only your fingers, "crawl" the hand forward on top of the towel until the arm is outstretched and the shoulder flexed. Hold for one to three seconds; return to the starting position. Do two sets of 15 to 20 repetitions.


Resources

WEB
www.mayoclinic.com/health/frozen-shoulder/DS00416 – The Mayo Clinic site provides an overview of frozen-shoulder symptoms, as well as causes, risk factors and treatments.

www.hopkinsmedicine.org/orthopedicsurgery/frozen.html – "The Johns Hopkins Medicine Patient Guide to Frozen Shoulder" includes anatomic diagrams.

www.aafp.org/afp/990401ap/990401c.html – The American Academy of Family Physicians site provides suggestions for basic exercises.