How to Thaw a Frozen Shoulder

Older athletes are more prone to suffer from the frozen shoulder syndrome, also referred to as adhesive capsulitis. Frozen shoulder is a condition that affects the shoulder joint capsule; a fibrous covering of the synovial lining of the shoulder joint. When the capsule becomes inflamed, it results in pain and significant stiffness of the joint. Due to these symptoms, the athlete quickly demonstrates a characteristic limitation in the range of motion of the shoulder.

How to Thaw a Frozen Shoulder

Understanding Frozen Shoulder/Adhesive Capsulitis

Frozen shoulder is a condition that affects the shoulder joint capsule: a fibrous covering of the synovial lining of the shoulder joint. When the capsule becomes inflamed, pain and significant joint stiffness ensue. Due to these symptoms, the athlete quickly experiences resulting limitation in the shoulder’s range of motion. Older athletes are more prone to suffer from frozen shoulder syndrome, also referred to as adhesive capsulitis, than their younger counterparts.

Restricted movement occurs with respect to both active and passive range of motions:

Active Motion: When the individual moves the joint with his own muscles

Passive Motion: When someone or something else moves the joint without active involvement from the individual

Individuals between the ages of 40 and 60 comprise the majority of those diagnosed with this injury, with women more prone than men. Interestingly, adhesive capsulitis is also more common in individuals previously diagnosed with diabetes. Shoulder pain is usually constant and aggravated by weather changes, keeping the joint in one place for too long, or activities requiring excessive shoulder movements.

Common Causes of Frozen Shoulder

  • Prolonged Immobilization: secondary to a rotator cuff injury, arm fracture, post-surgery immobilization, stroke, etc.
  • Premorbid Status: related to systemic diseases such as diabetes, abnormal thyroid function, tuberculosis, and chronic heart abnormalities
  • Any Shoulder Injury: specifically ailments that produce excessive inflammation such as tendonitis, bursitis, and inflamed rotator cuff muscles/tendons.  The four muscles that form the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis.

The typical course of frozen shoulder syndrome is broken into three phases, spanning almost a year’s worth of time:

1)    The “Freezing” Phase: The individual/athlete slowly develops tolerable pain and stiffness around the shoulder joint. Range of motion reduces almost proportionally to increased levels of pain. Discomfort leads the individual to subconsciously suppress active movement, resulting in a loss of range and strength. The pain is often worse at night, especially when laying on the affected side.

2)    The “Frozen” Phase: This stage’s inception is marked by the end of increasing discomfort, which the athlete subconsciously perceives as a decline in pain. Meanwhile, stiffness and reduced range of motion remain, regular routines are difficult, and muscle wasting (atrophy) becomes more evident. Rotating the arm outwards (external rotation) can become very difficult in this phase, which can last anywhere from about four months to a year.

3)    The “Thawing” Phase: Also called the recovery phase, range of motion in the shoulder starts to improve during this time. Strength and functional capacity gradually return, and this phase typically lasts 2 to 3 months.

Signs and Symptoms of a Frozen Shoulder

  • Increasingly stiff/immobile shoulder with pain around the joint
  • Dull, aching pain that occurs with motion and at rest
  • Shoulder girdle stiffness that restricts full range of motion with both active and passive movement
  • Localized pain felt throughout the outer shoulder area and upper arm
  • Sleep deprivation and possible transient insomnia

Professional Treatment for Frozen Shoulder/Adhesive Capsulitis

  • Intermittent icing with immediate range-of-motion exercises helps decrease pain and regain range of motion while the surrounding tissue is “numb” from the ice.
  • Work directly with a physical therapist, and if prescribed, anti-inflammatory medications can help when taken immediately prior to rehab sessions.
  • Gentle stretching exercises increase shoulder girdle range of motion.
  • Exercise the shoulder joint during activities of daily living (ADLs) to help foster motion.
  • In cases where aggressive rehab is ineffective or range-of-motion limits become excessive, a physician may recommend shoulder joint manipulation (performed under general anesthesia) to break up adhesions/tightness.

Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to the game they love:

1. Could this be a secondary complication of arthritis or another injury involving my shoulder joint?

2. Do I need an MRI to rule out other possibilities?

3. What is a realistic outcome for my injury?

4. What is the best rehabilitation facility in this area?

5. How soon can I return to my normal activities?

Elite Sports Medicine Tips from Mike Ryan

  • Take Rehab Seriously – Be proactive with your physical therapy, as its success will dictate your shoulder use for the next 1-2 years, period.
  • Know the Formula for Success Reducing inflammation + reprogramming muscles that move the shoulder joint = treatment victory
  • Don’t Panic Though our minds sometimes wander to the “Big C,” rest easy knowing a frozen shoulder is rarely associated with cancerous pathologies.
  • Stay Cool Warm Under Pressure Know that once cured, a frozen shoulder almost never comes back.

How to Survive a Rotator Cuff Tear

How to Survive a Rotator Cuff Tear

While thinking up the title for this article, I actually laughed out loud. Given the diversity of sources available to learn about rotator cuff injuries and boatload of corresponding data, surviving the information tsunami is more like it. Yet, knowledge is power, and here we are talking about it once more. Hopefully my colleagues will read this article and share in my humor without questioning the blatant hyperbole.

Okay, time to get serious. The rotator cuff is a group of four independent muscles that function to dynamically stabilize the glenohumeral (shoulder) joint.  The muscles bind to a cuff-like covering of the humerus (upper arm) bone to provide the shoulder joint with control and strength in both rotational and directional movements. Specifically, their main functions are:

  • Supraspinatus Muscle – Lift the arm out to the side (abduction) and slightly forward
  • Infraspinatus Muscle – Rotate the shoulder externally
  • Teres Minor Muscle – Rotate the shoulder externally
  • Subscapularis Muscle – Rotate the shoulder internally

Rotator cuff symptoms vary based on the degree and exact location of the injury. The most common rotator cuff injury is a strain or tear in the supraspinatus. Specifically, active individuals who perform a large amount of overhead throwing and lifting activities place excess strain and trauma on rotator cuff tissue.  In addition, external rotation (the weakest shoulder motion) contributes to the prevalence of impingement mechanisms upon the rotator cuff.

Rotator cuff injuries are grouped into two categories:

1. Tendinopathy – Inflammation or degeneration of a tendon

2. Tear or Strain – Disruption of a tendon and/or muscle

Signs and Symptoms of a Rotator Cuff Injury

Tendinopathy Symptoms:

  • Discomfort that can range from an ache to sharp, localized pain
  • Front shoulder tenderness that is more palpable when reaching behind the back, alongside general lateral deltoid pain with no associated tenderness in that area of the shoulder
  • Increased symptoms when raising and lowering the arm, especially when using a horizontal or shoulder-level range of motion
  • Noticeable weakness in most shoulder movements, especially when lifting the arm overhead and with resisted external rotation

Acute Rotator Cuff Tear Symptoms:

*Common causes of injury are suddenly falling on an outstretched arm or experiencing a rapid impact to the shoulder muscles, such as from the ground or an opposing player.*

  • Tearing sensation felt within the shoulder, immediately followed by significant pain throughout the shoulder girdle
  • Severe pain in a specific location followed by spasms and general shoulder joint stiffness
  • Weakness that ranges from minimal to severe enough to impair any active arm abduction (moving away from the side of the body), depending on the degree of tendon/muscle disruption
  • Limited active shoulder movement secondary to pain and weakness

Chronic Rotator Cuff Tear Symptoms:

*Chronic rotator cuff injuries develop over a period of time.  Due to excess impingement-type friction related to chronic pathology, the tear usually occurs at or near the tendon, typically on the dominant side. Athletes with this condition are generally over the age of 34.*

  • Ongoing symptoms with a gradual increase in both pain and weakness, both of which may become severe
  • Increased symptoms during rest and while sleeping on the involved side
  • Range of motion limitations and weakness that vary based on the location and severity of injury

Treating a Rotator Cuff Injury

  • It is important to obtain a detailed history of trauma to the shoulder, neck, chest and upper arm to help outline treatment based on the specific body part and tissue type.
  • A thorough bilateral assessment can point to major limiting factors: weakness, range of motion, and/or pain.
  • Work to progressively regain range of motion in the shoulder from the onset of the injury.
  • Apply ice to address any increase in shoulder joint warmth and soreness. When dealing with a chronic injury, utilize a contrast of warm/cold treatments to help increase blood flow.
  • Increasing strength without amplifying symptoms is a top priority when treating any type of a rotator cuff injury.  Employ a treatment program where special attention is paid to this balance, increasing the strength of external rotators while applying caution in overhead exercises.
  • Soft tissue massage and manual therapy to the shoulder, upper back and neck helps normalize mechanics of the entire shoulder girdle.
  • Implement scapula (shoulder blade) exercises early on in the rehab plan.  Enhance the strength and endurance of the shoulder stabilizers with activities such as planks, isometric arm holds and upper extremity weight-bearing medicine ball rolls.
  • Help improve proximal shoulder strength with distal extremity work such as hand-gripping, wrist curls and triceps extensions.
  • Sport-specific activities can be added to the treatment plan when shoulder strength returns to at least 75%, with extra caution given to all throwing and overhead activities.

Ask the Right Questions Like a Pro

Smart professional athletes with a rotator cuff injury who want to safely return to the field or court should ask their sports medicine specialist the following questions:

1. Are my rotator cuff symptoms due to an actual tear, or are they related to a tendinopathy?

2. Is an MRI or MRI Arthrogram needed to properly diagnose my injury?

3. How would you grade the strength in my affected shoulder, compared to the other side?

4. Do you think I will need rotator cuff surgery now or in the future?

5. Which physical therapist(s) do you recommend to rehab my injury?

Sports Medicine Tips for Living With a Rotator Cuff Injury

Get on Your Nerves – Body nerves can be fickle, so be sure your sports medicine specialist thoroughly evaluates your neck, muscles and shoulders to avoid missing any nerve-related reasons for your weakness.

Be a Chatty Cathy – That concussion last month…the pins and needles feeling you get when you sleep on that arm…these things do matter.  Tell your doctor anything and everything you know about signals from your body and let him/her figure out what’s not important.

Break Out Your Mental Scale – Don’t let the fact that you have a rotator cuff tear make you believe surgery is inevitable.  Weigh your lifestyle factors and corresponding limitations, along with the medical opinions of trusted professionals, before making the decision to go “under the knife.”

Take the Long View – Surgery or not, a rotator cuff injury dictates a long-term treatment plan.  This will provide a clear roadmap of stretches and strengthening exercises that you will do along with vulnerable activities/exercises you will not do.  Knowing both is important for an active future.